Socio-environmental context in monoclonal gammopathy of undetermined significance (MGUS) disparities

意义未明的单克隆丙种球蛋白病 (MGUS) 差异的社会环境背景

• 批准号: 10217474
• 负责人: Kimberly A Bertrand
• 金额: $ 76.01万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10217474
• 关键词: Address; Adolescence; Adult; Affect; African American; Archives; Behavior; Biological Assay; Blood; Blood specimen; California; Censuses; Characteristics; Childhood; Chronic; Classification; Climate; Collection; Country; Crowding; Data; Data Pooling; Development; Diabetes Mellitus; Diagnosis; Disease; Early Diagnosis; Economically Deprived Population; Educational Background; Educational Status; Environment; Environmental Pollution; Epidemiology; Etiology; Evaluation; Foundations; Genetic; Geography; Goals; Gold; Health; Incidence; Incidental Findings; Income; Individual; Infection; Intervention; Joints; Knowledge; Laboratories; Life; Light; Link; Malignant Neoplasms; Measures; Mediation; Methods; Monoclonal gammopathy of uncertain significance; Multiple Myeloma; Neighborhoods; Not Hispanic or Latino; Obesity; Outcome; Participant; Physical activity; Plasma Cells; Play; Population; Population Heterogeneity; Population Study; Prevalence; Prevention Measures; Psychosocial Stress; Questionnaires; Race; Research; Research Design; Research Support; Resources; Risk; Risk Factors; Risk Reduction; Role; Rural; Social Environment; Socioeconomic Status; Time; Underrepresented Populations; Woman; Women' s Health; biological specimen archives; black women; built environment; burden of illness; cohort; contextual factors; deprivation; epidemiology study; experience; fast food; high risk; improved outcome; indexing; innovation; insight; interest; lifestyle factors; low socioeconomic status; man; neighborhood association; neighborhood disadvantage; novel; population health; predictive modeling; racial disparity; racial diversity; screening; social determinants; social factors; socioeconomic diversity; socioeconomics; study population; teacher; walkability

ABSTRACT Compared to non-Hispanic whites, African Americans have a more than 2-fold higher incidence of multiple myeloma (MM) and its asymptomatic precursor condition, monoclonal gammopathy of undetermined significance (MGUS). However, the etiological factors underlying these racial disparities are not known and few epidemiologic resources are currently available to support research in diverse populations. Notably, there is little evidence that genetic factors explain these disparities; differences in prevalence of MGUS and MM by race may thus reflect external lifestyle and social factors. We posit that racial disparities are reflected in socioeconomic status (SES) and geospatial factors such as the “health” of the environment in which one lives (termed “built environment”), both of which are known to be linked to race and a variety of health outcomes. The Black Women's Health Study (BWHS) and the California Teachers Study (CTS), well-established complementary cohorts of women, provide a unique opportunity to study SES and built environment factors for MGUS in African American and non-Hispanic white women with up to 25 years of individual-level risk factor information, assessed through repeated health questionnaires, available as well as geocoded residential addresses. We propose an epidemiologic study pooling data from these two cohorts to evaluate the role of individual and neighborhood SES and the built environment in racial disparities in MGUS. Prevalent cases of MGUS will be identified by screening 8,000 cohort participants (3,300 in BWHS and 4,700 in CTS) with archived blood specimens using gold-standard laboratory assays for the diagnosis of MGUS; we expect to identify 660 cases of MGUS (including 330 African American and 330 non-Hispanic white women). We hypothesize that neighborhood disadvantage and attributes of the built environment that inhibit healthy behaviors increase risk and contribute to known racial disparities in MGUS. We will determine associations of neighborhood deprivation and markers of individual SES, such as educational achievement, parental education level, income, and early life financial instability, in relation to MGUS overall and by race. We will also explore how characteristics of the built environment, such as urbanicity and neighborhood walkability, and the cross- classification of these variables with SES, are associated with MGUS and may explain observed differences in prevalence by race. Our proposed study is particularly innovative because it moves beyond the traditional, single-level predictor model to an approach that addresses the complexity of both individual- and contextual- level predictors for disease. The wide geographic/rural-urban, racial, and socioeconomic diversity of our study population across cohorts makes it an ideal setting in which to interrogate the intersection between race, SES, and neighborhood attributes on MGUS and MM risk. This research therefore has great potential to advance current knowledge about MGUS etiology, to inform opportunities for risk reduction in high-risk understudied populations, and to close the gap in racial disparities in multiple myeloma and its precursor conditions.

摘要