Promoting Diversity and Sustainability in the NIDDK-Supported Research Workforce through Mentoring Early Career Investigators: Focus on Health Equity

项目摘要/摘要 这项提议的广泛、长期的目标有两个：1)提供高质量的指导，以做出贡献 对不同背景的实习生的职业发展和2)提高质量，严谨和 移植和儿科肾脏病的健康公平研究的广度。 几十年来，人们已经认识到，黑人和西班牙裔接受肾脏移植的可能性较小 与非西班牙裔白人(NHW)相比，尤其是来自活着的捐赠者。发表最多的差异研究 将种族/民族作为一种社会结构，并将移植机会和结果的差异归因于 健康的社会决定因素(SDOH)。然而，对SDOH的评估往往仅限于种族/民族、健康 保险状况和社区贫困水平，大多数研究都是描述性的，很少提供 可采取行动的结果，以减轻不平等。此外，拟议的干预措施通常是针对个人的 而不是使系统性种族偏见永久化的医疗体系。实现以下目标的另一个挑战 移植准入的公平性在于国家数据的限制。目前，国家监控登记机构捕获 患者何时开始肾脏替代治疗(美国肾脏数据系统) 等待名单或移植(移植受者科学登记)，但不包括在 在患者必须接受移植转诊和评估被认为符合移植条件之间。 在这种情况下，移植界呼吁采取行动，实现移植的公平。 通过提高移植相关健康公平研究的严谨性、质量和透明度。阿马拉尔博士的研究 该提案寻求从描述差异转向在移植机会和结果方面实现公平 通过利用不同的研究设计和不同的数据源进行研究，以确定潜在的 可修改的医疗体系对移植准入设置了障碍。目前的两个项目将支持这一奖项。这个 REACH-移植研究(R01 DK120886)检查了在接受和移植过程中出现的种族/民族不平等 活体供体评估、活体供体选择和活体供体随访。这项研究有三个目标，两个都适用 一次和二次数据收集、大量电子健康记录、研究队列数据和调查数据。 第二个项目，家庭召唤项目，侧重于识别和解决不利的社会问题 影响儿童肾移植评估完成的健康决定因素(SDOH)。本研究 将使用访谈和调查数据。这些研究为卫生公平研究提供了强有力的培训机会 对于阿马拉尔博士作为导师，以及对许多层次和背景的受训者来说，提出这个建议是理想的 与K26奖励机制的总体目标保持一致。

Project Summary/Abstract The broad, long-term objectives of this proposal are two-fold: 1) to provide high-quality mentoring to contribute to the career development of trainees from diverse backgrounds and 2) to advance the quality, rigor and breadth of health equity research in transplantation and pediatric nephrology. For decades, it has been recognized that Blacks and Hispanics are less likely to receive kidney transplantation compared with non-Hispanic whites (NHWs), especially from a living donor. Most published disparities studies have used race/ethnicity as a social construct and attributed differences in transplant access and outcomes to social determinants of health (SDOH). Yet, assessments of SDOH are often limited to race/ethnicity, health insurance status and neighborhood poverty level, and most studies are descriptive with few providing actionable findings to mitigate inequities. Further, proposed interventions are often targeted at the individual patient rather than the healthcare systems that perpetuate systemic racial bias. Another challenge in achieving equity in transplant access lies in the limits of national data. Currently, national surveillance registries capture patients when they begin renal replacement therapy (United States Renal Data System) and when they are waitlisted or transplanted (Scientific Registry of Transplant Recipients), but not what happens during the time in between when patients must undergo transplant referral and evaluation to be deemed transplant eligible. Given this context, the transplant community has asserted a call to action to achieve equity in transplantation by improving rigor, quality and transparency in transplant-related health equity research. Dr. Amaral’s research proposal seeks to move from describing disparities to achieving equity in transplant access and outcomes through research that leverages diverse study designs and varied data sources to identify potentially modifiable healthcare system barriers to transplant access. Two current projects will support this award. The REACH-TRANSPLANT study (R01 DK120886) examines racial/ethnic inequities that arise during recipient and living donor (LD) evaluation, LD selection, and LD follow-up. The study has three aims and applies both primary and secondary data collection, large electronic health records, research cohort data and survey data. The second project, The House Calls Project, focuses on identifying and addressing adverse social determinants of health (SDOH) that interfere with pediatric kidney transplant evaluation completion. This study will use interview and survey data. These studies provide robust training opportunities in health equity research for Dr. Amaral as a mentor and for mentees across many levels and background, making this proposal ideally aligned with the overarching goals of the K26 award mechanism.