The Role of Structural Racism on Disparities in Clinical Outcomes for Diabetes: A Mixed Methods Study

结构性种族主义对糖尿病临床结果差异的作用：混合方法研究

• 批准号: 10634279
• 负责人: Joni Strom Williams
• 金额: $ 67.85万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-23 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10634279
• 关键词: 18 year old; Address; Adult; Area; Attitude; Behavior; Belief; Black race; Blood Glucose; Body mass index; Caring; Chronic; Classification; Clinical; Communities; Data; Diabetes Mellitus; Diagnosis; Diet; Discrimination; Disparity; Economics; Education; Employment Opportunities; Environment; Ethnic Origin; Fostering; Gender; Green space; Health; Health Food; Healthcare; Housing; Individual; Inequity; Institutional Practice; Interview; Knowledge; Laws; Lipids; Methods; Minority Groups; Modeling; Morbidity - disease rate; Neighborhoods; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Outcome; Pathway interactions; Persons; Physical activity; Policies; Population Group; Poverty; Process Measure; Qualitative Research; Quality of life; Race; Racial Segregation; Recreation; Reporting; Research Design; Research Methodology; Resources; Risk; Role; Scholarship; Security; Self Care; Societies; Structural Racism; Structure; System; Transportation; United States; Variant; behavioral outcome; blood pressure control; design; diabetes management; diabetes self-management; digital; economic disparity; ethnic minority population; experience; glucose monitor; glycemic control; health care availability; health inequalities; medication compliance; mortality; population health; racial minority population; segregation; sex; social; social disparities; social health determinants; urban setting

Approximately 37.1 million adults 18 years or older (14.7% of all U.S. adults) are estimated to have diabetes, where 90-95% of cases are classified as type 2 diabetes mellitus (T2DM). Adults from racial/ethnic minority groups continue to be disproportionately impacted by higher morbidity and mortality and poor outcomes compared to Non-Hispanic White adults. The reasons for these disparities among population groups remain elusive; however, structural racism, defined as the laws, policies, institutional practices, and entrenched norms embedded within society that foster discrimination through mutually reinforcing inequitable systems, has been indicated as a root cause of inequities in health outcomes including those related to diabetes. One form of structural racism, historic redlining, known as the practice of denying resources to communities based on race, largely impacts neighborhoods populated by persons from racial and ethnic minority groups where diabetes is highly prevalent. It has led to social and economic disadvantage within hyper-segregated and under-resourced neighborhoods due to community disinvestment. Despite reportedly being banned decades ago, the relationship between historic redlining and contemporary diabetes outcomes has not been well- studied. Since current evidence supports an association between redlining and population health, this is a significant gap that needs to be addressed to reduce diabetes disparities. Preliminary data from our group shows people report that current studies do not account for their lived experiences or accommodate for the structural inequities they deal with that limits their ability to self-manage diabetes. Therefore, we propose to assess the role of structural racism, in the form of historic redlining, on diabetes disparities and how it impacts current-day clinical and behavioral outcomes, quality of life, and the neighborhood environment in 2,000 adults with T2DM. This study offers a unique opportunity to bridge a gap in knowledge within the field by using an experimental convergent mixed methods study design to understand the relationship between historic redlining and diabetes-related outcomes in adults with T2DM. Aim 1 will use qualitative research methods to explore beliefs and attitudes about historic redlining and its impact on diabetes self-management and outcomes. Aim 2 will use quantitative research methods to identify direct and indirect pathways through which historic redlining impacts diabetes- related outcomes (glycemic control, blood pressure control, lipid control, self-care behaviors (diet, physical activity, medication adherence, blood glucose monitoring), and quality of life) in adults with T2DM and investigate invariance by race/ethnicity and sex/gender in the relationship. Aim 3 will use hierarchical modeling to assess the impact of individual, interpersonal, and neighborhood level factors on individual level diabetes outcomes; to assess the contribution of historic redlining exposure toward noted neighborhood level associations; and to assess whether individual level associations are moderated by historic redlining exposure.

据估计，大约有 3710 万 18 岁或以上的成年人（占美国成年人总数的 14.7%）患有糖尿病， 其中 90-95% 的病例被归类为 2 型糖尿病 (T2DM)。少数种族/族裔的成年人 较高的发病率和死亡率以及不良结果仍然对不同群体造成不成比例的影响 与非西班牙裔白人成年人相比。人口群体之间存在这些差异的原因仍然存在 难以捉摸；然而，结构性种族主义被定义为法律、政策、制度实践和根深蒂固的种族主义。 社会中根深蒂固的规范通过相辅相成的不平等制度助长了歧视， 被认为是健康结果不平等的根本原因，包括与糖尿病相关的健康结果。一种形式 结构性种族主义、历史性红线，即基于以下原因拒绝向社区提供资源的做法： 种族，很大程度上影响了少数种族和族裔群体居住的社区，其中 糖尿病非常普遍。它导致了高度隔离的社会和经济劣势 由于社区投资减少，社区资源不足。尽管据报道被禁止数十年 以前，历史红线与当代糖尿病结果之间的关系并不好—— 研究过。由于目前的证据支持红线与人口健康之间的关联，因此 这是一个需要解决的重大差距，以减少糖尿病差异。初步数据来自 我们的小组显示人们报告说当前的研究没有考虑到他们的生活经历或 适应他们所面临的结构性不平等，这限制了他们的自我管理能力 糖尿病。因此，我们建议以历史性种族主义的形式评估结构性种族主义的作用。 关于糖尿病差异及其如何影响当前临床和行为结果的红线， 2000 名 T2DM 成年人的生活质量和社区环境。这项研究提供了一个独特的 通过使用实验聚合混合来弥合该领域内知识差距的机会 方法研究设计以了解历史红线与糖尿病相关之间的关系 成人 T2DM 的结果。目标 1 将使用定性研究方法来探索信念和态度 关于历史红线及其对糖尿病自我管理和结果的影响。目标 2 将使用定量 研究方法来确定历史红线影响糖尿病的直接和间接途径 相关结果（血糖控制、血压控制、血脂控制、自我护理行为（饮食、身体健康） 成年 T2DM 患者的活动、药物依从性、血糖监测）和生活质量） 研究关系中种族/民族和性别/性别的不变性。目标 3 将使用分层建模 评估个体、人际和邻里层面因素对个体糖尿病的影响 结果；评估历史红线暴露对著名社区水平的贡献 协会；并评估个人层面的关联是否受到历史红线暴露的调节。