ACHIEVE GreatER: Addressing Cardiometabolic Health Inequities by Early PreVEntion in the Great LakEs Region

摘要 在现有合作的基础上，利用知识资源和基础设施 在三个主要的研究机构，两个在底特律（韦恩州立大学和亨利福特健康 一个在克利夫兰（凯斯西储大学/大学医院）， GREATER中心将，i）通过部署一套 在社会脆弱性较高的人口普查区提供社区参与资源， ii）实施、评估和维持一个以证据为基础的社区卫生的升级版本 工人干预，通过解决多个层面的 在不同领域的影响力，以及iii）培养一支训练有素、处于职业早期阶段的多元化员工队伍 研究人员共同致力于减轻慢性心血管疾病的差异，推动美国 寿命不平等除了在三个合作机构之间开展试点赠款计划外， ACHIEVE GREATER将执行三个不同但密切相关的特别项目， 在不同情况下中断发病的早期阶段（例如，移动的保健单位与固定的保健单位 社区位置）。重要的是，这项工作将嵌套在一个更大的流行病学研究的多层次 心脏代谢危险因素。我们的团队将开发一个基于云的分布式数据库， 定制的一套信息学工具，使调查人员能够在每个城市的中心， 使用公开信息和研究者，跨不同领域的多水平风险因素- 生成的数据。我们的循证干预途径旨在控制风险因素，特别是 血压升高，这是心脏病最重要的可改变的贡献者-远远超过 是我们地区的主要死因通过扩大在社会脆弱性增加的人口普查区的覆盖面 在寿命差异和不受控制的心脏代谢风险因素最普遍的地方，我们的研究设计 优化招募机会和潜在干预影响。此外， 三个机构的资源将有效加强区域协调，同时增加 以及研究参与者的多样性和训练有素的职业生涯早期阶段差异调查人员。如果我们 成功且具有成本效益，那么我们将展示一种可扩展的方法， 通过优先控制来自极端社会风险地区的高风险人群的风险因素， 易损性.

ABSTRACT Building upon the strength of existing collaborations and leveraging the intellectual resources and infrastructure across three major research institutions, two in Detroit (Wayne State University and the Henry Ford Health System) and one in Cleveland (Case Western Reserve University/University Hospitals), the ACHIEVE GREATER Center will, i) increase reach in areas with extreme social vulnerability by deploying a suite of community engagement resources in census tracts with heightened social vulnerability, ii) implement, evaluate and maintain an upscaled version of an evidence-based community health worker intervention to control multi-comorbid chronic cardiometabolic diseases by addressing multiple levels of influence across different domains, and iii) foster a diverse workforce of well-trained, early-career stage investigators who collectively focus on alleviating chronic cardiovascular disease disparities that drive U.S. lifespan inequality. In addition to conducting a pilot grants program across the three partnering institutions, ACHIEVE GREATER will perform three distinct but closely related special projects that focus on interrupting early stages of pathogenesis in different contexts (e.g., mobile health units versus fixed community locations). Importantly, this work will be nested in a larger epidemiologic study of multi-level cardiometabolic risk factors. Our team will develop a distributed Cloud-based database complete with a customized set of informatics tools that will enable investigators in the heart of each city to robustly profile multi-level risk factors across different domains using both publicly available information and investigator- generated data. Our evidence-based intervention pathways are designed to control risk factors, especially elevated blood pressure, which is the most important modifiable contributor to heart disease - far and away the leading cause of death in our region. By increasing reach in census tracts with increased social vulnerability where lifespan disparities and uncontrolled cardiometabolic risk factors are most prevalent, our study design optimizes both recruitment opportunities and potential intervention impact. Moreover, the alignment of resources across three institutions will efficiently enhance regional coordination, while increasing the number and diversity of research participants and highly trained early-career stage disparities investigators. If we are successful and cost-effective, then we will have demonstrated a scalable means of improving future lifespan equality by prioritizing risk factor control in high-risk populations from areas with extreme social vulnerability.