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

将社会行为背景因素和稳态负荷与不同亚裔美国人的慢性病联系起来：推进精准医疗和健康公平的社会生态学方法

• 批准号: 10799170
• 负责人: Lin Zhu
• 金额: $ 23.77万
• 依托单位: TEMPLE UNIV OF THE COMMONWEALTH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-19 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10799170
• 关键词: Acceleration; Acculturation; Age; Aging; Alcohol consumption; All of Us Research Program; Anxiety; Asian; Asian Americans; Asian Indian; Behavior; Behavior Therapy; Behavioral; Biomedical Research; Body mass index; Cambodian; Cardiovascular Diseases; Chinese; Cholesterol; Chronic; Chronic Disease; Chronic lung disease; Chronic stress; Clinical; Cluster Analysis; Communities; Complex; Coronary heart disease; Country; Data; Diabetes Mellitus; Discrimination; Disparity population; Drug Use Disorder; East Asian; Education; Endocrine; Ethnic Origin; Ethnic Population; Filipino; Filipino American; Functional disorder; Future; Growth; Hate; Health; Health behavior; Healthcare Systems; Heterogeneity; Hypertension; Hypothyroidism; Immigrant; Immune system; Impaired cognition; Income; Intervention; Japanese; Knowledge; Koreans; Life; Life Style; Limited English Proficiency; Link; Literature; Logistic Regressions; Loneliness; Malignant Neoplasms; Malignant neoplasm of liver; Marital Status; Mediating; Mediation; Medical; Mental Depression; Mental disorders; Metabolic; Minority; Modeling; Morbidity - disease rate; Neighborhoods; Non-Insulin-Dependent Diabetes Mellitus; Pakistan; Pathway interactions; Pattern; Peripheral Vascular Diseases; Physiological; Population; Precision Health; Principal Component Analysis; Race; Reduce health disparities; Refugees; Research; Research Personnel; Risk; Sampling; Scientific Advances and Accomplishments; Smoking; Social Behavior; Social Environment; Social support; Socioeconomic Status; South American; South Asian; Stress; Stroke; Subgroup; System; Tobacco use; Trauma; Variant; Vietnamese; allostatic load; anti-Asian; built environment; burden of illness; cancer risk; cardiometabolism; cohesion; contextual factors; demographics; disorder prevention; experience; health equity; high risk; high risk population; improved; lens; lifestyle intervention; men; multiple chronic conditions; personalized medicine; precision medicine; prevent; promote resilience; psychologic; racial diversity; racial population; racism; sex; sociodemographics; southeast Asian

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.

项目总结/文摘