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

摘要 在现有协作的基础上构建优势并利用智力资源和基础设施 三个主要的研究机构，底特律的两个(韦恩州立大学和亨利·福特健康 系统)和一个在克利夫兰(凯斯西部储备大学/大学医院)，实现 大中心将，i)通过部署一套 在社会脆弱性较高的人口普查地区的社区参与资源， 二)实施、评价和维持循证社区卫生的升级版本 通过多层次干预控制多种慢性心脏代谢性疾病 跨不同领域的影响力，以及三)培养训练有素的早期职业生涯阶段的多样化劳动力 调查人员集体致力于缓解推动美国经济增长的慢性心血管疾病差距。 寿命不平等。除了在三家合作机构之间进行一项试点赠款计划外， 实现更大将执行三个截然不同但密切相关的特别项目，重点是 在不同情况下(例如，流动医疗单位与固定医疗单位)中断发病的早期阶段 社区位置)。重要的是，这项工作将嵌套在更大的多层次流行病学研究中 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， 一套定制的信息学工具，使每个城市中心的调查人员能够有力地分析 使用公开可用信息和调查人员，跨不同领域的多级别风险因素- 生成的数据。我们的循证干预路径旨在控制风险因素，特别是 高血压，这是心脏病最重要的可改变因素--毫无疑问 是我们地区的主要死因。通过在社会脆弱性增加的人口普查地区扩大覆盖范围 在寿命差异和心脏代谢风险因素最普遍的地方，我们的研究设计 优化招聘机会和潜在的干预影响。此外，还包括 三个机构的资源将有效地加强区域协调，同时增加 以及研究参与者的多样性和训练有素的早期职业生涯差异调查员。如果我们是 成功且具有成本效益，那么我们将展示一种可扩展的改善未来的方法 通过优先控制来自极端社会地区的高危人群的风险因素来实现寿命平等 脆弱性。

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.