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

项目总结/摘要 亚裔美国人（AA）是美国增长最快、最多样化的种族/族裔群体，占美国人口的81%。 从2000年到2019年的增长。与“模范少数族裔神话”相反，AA在收入上有很大的差异， 受教育程度和出生状况。AA也有独特的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 作为移民或难民，以及导航不熟悉的医疗系统。不幸的是，缺乏分类 数据限制了我们对不同AA人群非稳态负荷（AL）的理解。因此，我们建议 通过非稳态负荷的概念向理解慢性压力的累积代价的范式转变， 它的行为和社会背景的相关性，以及AL如何表现为慢性疾病之间的AA，由亚洲 种族亚群。人工晶状体是一种复杂的临床结构，它提供了一种独特的透镜，可以承受累积的应力 以及它如何表现为生理和心理功能障碍（即慢性疾病）。分析 需要分类数据来揭示AA亚组的特定风险模式并减少健康差异 通过有针对性的干预。我们所有人（AoU）研究计划提供了前所未有的机会， 我们缩小了文学的差距，促进了科学知识的发展。利用多样化和包容性的AA 子样本（N = 12，408），我们试图将AL建模为一个复杂的系统，以捕捉更全面的 健康风险在AA亚组，确定高危人群，并探讨如何AL作为各种慢性疾病。所有 首先在AA样本中进行分析，然后在4个种族/地区亚组中进行分析：东亚 （中国人、日本人、韩国人）、东南亚人（越南人、柬埔寨人、苗族人）、南亚人（印度人、 巴基斯坦和菲律宾。具体目标如下：目标1：审查生理风险概况， 社会人口统计学、行为、社会背景和文化适应相关因素如何与AL相关 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， 菲律宾裔美国人（Aim 1B）。目的2：探讨亚组差异的压力表现， AL如何与聚集的（Aim 2a）和单独的AA亚组中的多种慢性疾病相关（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确定临床和社会- 在生理和心理失调的高风险中的人口统计学上重要的AA亚组。与 由研究人员和临床/社区利益相关者共同领导的传播活动，本研究最终将 指导未来的生活方式和行为干预措施，以提高AA的弹性，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.