Linking Social-Behavior Contextual Factors and Allostatic Load to Chronic Diseases in Diverse Asian Americans: A Socioecological Approach to Advancing Precision Medicine and Health Equity

项目摘要/摘要 亚裔美国人(AA)是美国增长最快、最多元化的种族/民族群体，占81% 从2000年到2019年的增长。与“模范少数族裔神话”相反的是，机管局的收入差异很大， 教育程度，以及各分组的出生状况。AAS也有独特和不平等的健康行为模式， 心脏代谢疾病、内分泌功能障碍、癌症和精神疾病。我们还必须承认 不同AA人群的生活经历：历史创伤、种族主义、重新适应新国家的生活 以移民或难民的身份，以及在陌生的医疗体系中导航。不幸的是，缺乏分类的 数据限制了我们对不同AA人群中的不平衡负荷(AL)的理解。因此，我们提出一项 范式转变为通过非静态负荷的概念来理解慢性应激的累积损失， 它的行为和社会背景相关，以及AL如何在AA中表现为慢性病，由亚洲人 种族亚群。AL是一个复杂的临床结构，为了解压力的累积死亡人数提供了一个独特的视角 以及它如何表现为生理和心理功能障碍(即慢性病)。分析了 需要分解数据来发现AA亚组的特定风险模式，并减少健康差异 通过量身定做的干预。我们所有人(AOU)研究计划为 我们需要弥合文学方面的差距，推进科学知识。利用多样化和包容性的AA 子样本(N=12,408)，我们试图将AL建模为一个复杂系统，以捕获更全面的范围 AA亚组的健康风险，识别高危人群，并探索AL如何作为各种慢性病。全 分析将首先在总计AA样本中进行，然后在4个种族/地区分组中进行：东亚 (汉语、日语、韩语)、东南亚(越南、柬埔寨、苗族)、南亚(印度、 巴基斯坦)和菲律宾人。具体目标如下：目标1：检查生理风险概况和 社会人口统计、行为、社会背景和文化适应相关因素与AL的关系 在聚集的亚裔美国人(AIM 1a)和单独的AA亚组(东亚、东南亚、南亚、 和菲律宾裔美国人)(目标1b)。目的2：通过研究不同亚组应激表现的差异 在聚集(目标2a)和单独的AA亚组(EAST， 东南部、南部和菲律宾裔美国人)(目标2b)。拟议的分析将有助于在临床和社会上识别 在人口统计学上重要的AA亚群是生理和心理失调的高危人群。使用 由研究人员和临床/社区利益相关者共同领导的传播活动，这项研究最终将 指导未来的生活方式和行为干预以提高AA患者的复原力，并提供临床意义 寻求更个性化的药物来缓解压力和预防慢性病。

PROJECT SUMMARY/ABSTRACT Asian Americans (AA) are the fastest growing and most diverse racial/ethnic group in the US, recording a 81% growth from 2000 to 2019. Counter to the “model minority myth,” the AA has broad variations in income, education, and nativity status by subgroups. AAs also have unique and unequal patterns of health behaviors, cardiometabolic conditions, endocrine dysfunction, cancer, and mental illness. We must also acknowledge the lived experiences of the diverse AA populations: historical trauma, racism, re-adjusting to life in a new country as immigrants or refugees, and navigating unfamiliar healthcare systems. Unfortunately, lack of disaggregated data limited our understanding of allostatic load (AL) in the diverse AA populations. Therefore, we propose a paradigm shift towards understanding the cumulative toll of chronic stress through the concept of allostatic load, its behavioral and social-contextual correlates, and how AL manifests as chronic diseases among AAs, by Asian ethnic subgroups. AL is a complex clinical construct that offers a unique lens into the cumulative toll of stress and how it manifests as physiological and psychological dysfunctions (i.e. chronic conditions). Analyses of disaggregate data are needed to uncover specific risk patterns by AA subgroups and reduce health disparities through tailored interventions. The All of Us (AoU) Research Program provides unprecedented opportunities for us to close the gaps in literature and advance scientific knowledge. Leveraging the diverse and inclusive AA subsample (N = 12,408), we seek to model AL as a complex system to capture a more comprehensive extent of health risk in AA subgroups, identify high-risk groups, and explore how AL as various chronic illnesses. All analyses will be conducted in aggregate AA sample first and then in 4 ethnic/regional subgroups: East Asian (Chinese, Japanese, Korean), Southeast Asian (Vietnamese, Cambodian, Hmong), South Asian (Indian, Pakistan), and Filipino. The specific aims are as follows: Aim 1: To examine the physiological risk profiles and how sociodemographic, behavioral, social-contextual, and acculturation-related factors are associated with AL in aggregated Asian American (Aim 1a) and separate AA subgroups (East Asian, Southeast Asian, South Asian, and Filipino Americans) (Aim 1b). Aim 2: To explore subgroup disparities in stress manifestations by examining how AL is associated with multiple chronic conditions in aggregated (Aim 2a) and separate AA subgroups (East, Southeast, South, and Filipino Americans) (Aim 2b). The proposed analyses will help identify clinically and socio- demographically important subgroups of AAs at high risk for physiological and psychological dysregulation. With dissemination activities jointly led by researchers and clinical/community stakeholders, this study will ultimately guide future lifestyle and behavioral interventions to improve resilience in AAs and provide clinical implications for a more personalized medicine to stress mitigation and chronic disease prevention.