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/文摘

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.