Elucidating Social Determinants and Mental Health Needs to Achieve Equity in Rheumatic Disease Care

项目摘要/摘要 风湿性疾病系统性红斑狼疮、类风湿性关节炎和骨性关节炎 影响多达四分之一的美国人口，带来巨大的身体、社会、心理和经济方面的影响 负担。在患有这些疾病的人中，可以看到在护理和结果方面存在严重差异， 妇女和历史上被边缘化的人口受到不成比例的影响。的社会决定因素 健康(SDoH)，包括社会风险因素，如粮食不安全和财政压力，以及潜在的 这些风险的缓冲，如社会支持，尚未作为风湿病护理的一部分进行常规评估 直接影响患有风湿病的人的健康，并可能加剧差异。那些 患有这些风湿病的人更有可能有心理健康问题，特别是 严重抑郁症和创伤后应激障碍(PTSD)，以及新兴的研究指出分享 精神健康障碍和自身免疫性风湿病的遗传易感性。很多人 患有风湿病的人得不到及时、高质量的护理或充分的预防性保健 导致急诊科就诊和住院人数增加，这通常是可以避免的 结果包括疫苗可预防的感染和重大心血管事件。利用所有 美国数据，我们提出了新的研究来解决可修改的障碍 风湿病患者获得医疗保健的机会和结果，这是一个独特的高危群体，原因是 这些疾病造成的物质和经济负担以及历史上被边缘化的人口最多 受影响。到目前为止，SDoH和精神健康状况的影响，以及潜在的缓冲因素 可能会被优化，但审查不力，几乎没有得到解决。我们将对这些关键问题进行调查 我们所有人对50,000名风湿病患者与电子健康相关的问题 记录、关于SDoH的调查、人口统计、医疗保健服务和基因分型数据。其中 对于患有风湿病的个体，我们将1)使用社会风险因素指数来评估SDoH的效果 2)检查抑郁症和创伤后应激障碍对可避免的急性护理的影响 住院和心血管事件，占社会因素的比例。我们将采用经过验证的 抑郁症和创伤后应激障碍的多基因风险评分，以了解不同人群遗传风险的差异 并尽可能评估高遗传风险对急性护理使用的影响 未诊断、未治疗疾病的标志物。我们的发现，理解这些因素的相互作用 未得到充分研究的因素，将使干预措施开始实现公平的护理和结果 受风湿病影响最大。

PROJECT SUMMARY/ABSTRACT The rheumatic diseases systemic lupus erythematosus, rheumatoid arthritis, and osteoarthritis together affect up to one-quarter of the U.S. population, with huge physical, social, psychological and financial burdens. Profound disparities in care and outcomes are seen among those afflicted with these diseases, with women and historically marginalized populations disproportionally impacted. Social determinants of health (SDoH) including social risk factors such as food insecurity and financial strain, as well as potential buffers of these risks such as social support, are not routinely assessed as part of rheumatology care yet directly impact the health of individuals with rheumatic diseases and likely exacerbate disparities. Those suffering with these rheumatic diseases are much more likely to have mental health conditions, notably major depression and post-traumatic stress disorder (PTSD), and emerging research points to shared genetic predisposition to mental health disorders and autoimmune rheumatic diseases. Many individuals with rheumatic diseases do not receive timely, high-quality care or adequate preventive healthcare resulting in increased emergency department visits and hospitalizations for oftentimes avoidable outcomes including vaccine-preventable infections and major cardiovascular events. Leveraging All of Us data from a large and diverse U.S. population, we propose novel studies to address modifiable barriers to healthcare access and outcomes for patients with rheumatic diseases, a unique at-risk group due to the physical and financial burdens of these diseases and the historically marginalized populations most affected. To date, the influence of SDoH and mental health conditions, and potential buffering factors that could be optimized, have been poorly examined and little addressed. We will investigate these crucial questions within All of Us with >50,000 individuals with rheumatic diseases with linked electronic health records, surveys regarding SDoH, demographics, healthcare access, and genotyping data. Among individuals with rheumatic disease, we will 1) use a social risk factor index to assess the effects of SDoH on recurrent, avoidable acute care use and 2) examine the impact of depression and PTSD on avoidable hospitalizations and cardiovascular events, accounting for social factors. We will employ validated polygenic risk scores for depression and PTSD to understand differences in genetic risk among individuals with rheumatic diseases and assess effects of high genetic risk on acute care use as possible markers for undiagnosed, untreated disease. Our findings, understanding the interplay of these understudied factors, will allow interventions to begin to achieve equitable care and outcomes for those most affected by the rheumatic diseases.