Atopic dermatitis in an urban adult population: identifying the role of social and environmental factors

摘要 特应性皮炎（AD）是一种常见的慢性皮肤炎性疾病，影响10%的成年人。AD是 与主要健康相关的生活质量（QoL）和心理社会损害相关， 其他严重的慢性疾病，如心脏病、糖尿病、高血压等。尽管主要的物理 以及伴随AD的情感负担，它仍然是成年人中研究不足的皮肤病，因为， 直到最近，AD一直被错误地认为是一种在成年后缓解的儿童疾病。重要的是， 我们的初步数据显示，种族/民族差异的严重程度，生活质量的影响，和卫生保健利用 提示AD结局存在差异，值得进一步研究。考虑 由于美国人口的预期多样化，如果不采取措施，这种差距只会恶化 没有地址然而，识别、理解并最终消除种族/族裔歧视的一个关键障碍是， 由于缺乏足够的种族/民族背景的成人AD队列， 多样性和个人层面的社会和环境背景数据，这是全面 评估这种差异的原因。为了解决这一障碍，我们建议建立一个队列， 在社会经济上处于不利地位和医疗上处于不利地位的不同种族和民族的AD成年人 宾夕法尼亚州费城北部的一个服务不足的城市社区。北费城成年居民 代表了容易受到AD严重负担的人群。在这个队列中，我们的目标是执行一个 纵向队列研究：i）确认并进一步描述AD结局中现有的种族/民族差异 和成人AD的医疗保健利用，以及ii）确定个人行为，社会和 环境背景因素同时导致AD结果中的种族/民族差异。我们 我将利用一种新的跨学科方法和一种连续的混合方法研究来解决这些目标 设计，以便在我们的研究中纳入成人AD患者的生活经验。我们假设 具体的和潜在的可改变的行为，社会和环境因素有助于种族/民族 AD结果的差异。从拟议的工作中获得的新知识对于以下方面至关重要： 为未来个人和社区一级的干预提供信息，以减少种族/族裔差异， 类似城市成年人群的AD结局。

ABSTRACT Atopic dermatitis (AD) is a common, chronic inflammatory disease of the skin that affects 10% of adults. AD is associated with major health-related quality-of-life (QoL) and psychosocial impairments that exceed those of other serious chronic diseases such as heart disease, diabetes, and hypertension. Despite the major physical and emotional burdens that accompany AD, it remains an understudied skin disease among adults because, until recently, AD had been incorrectly considered a childhood disease that remits in adulthood. Importantly, our preliminary data reveal racial/ethnic differences in the severity of, QoL impact of, and health care utilization for AD that suggest the presence of disparities in AD outcomes that deserve further study. Considering the anticipated diversification of the U.S. population, such disparities are only expected to worsen if left unaddressed. However, a critical barrier to identifying, understanding, and ultimately eliminating racial/ethnic disparities in AD outcomes among adults exists due to the lack of adult AD cohorts with sufficient racial/ethnic diversity and individual-level social and environmental contextual data that are necessary to comprehensively evaluate the causes of such disparities. In order to address this barrier, we propose to create a cohort of racially and ethnically diverse adults with AD within the socioeconomically disadvantaged and medically underserved, urban neighborhood of North Philadelphia, Pennsylvania. North Philadelphia adult residents represent a population that is vulnerable to a large burden of AD. With this cohort, we aim to perform a longitudinal cohort study to: i) confirm and further characterize existing racial/ethnic disparities in AD outcomes and health care utilization for AD among adults, and ii) identify the individual behavioral, social, and environmental contextual factors that simultaneously contribute to racial/ethnic disparities in AD outcomes. We will address these aims utilizing a novel transdisciplinary approach and a sequential mixed methods study design in order to incorporate the lived experience of adults with AD in our studies. We hypothesize that specific and potentially modifiable behavioral, social, and environmental factors contribute to racial/ethnic disparities in AD outcomes. The new knowledge that will be gained from the proposed work is essential to informing future individual- and community-level interventions to reduce racial/ethnic disparities and improve AD outcomes among similar urban adult populations.