Leveraging Spatial Epidemiology to Reduce Hypertension Disparities

项目总结 高血压影响了一半的美国成年人，但对非裔美国人造成了特别严重的负担。 高血压诊断、治疗和控制结果的差异在空间上是有模式的。这个空间 模式假设是由地区层面的社会经济风险因素和地区层面的结构性资源造成的 (例如，健康食品、娱乐、医疗保健和住房)。利用详细的空间数据提供独特的 有机会深入到共同区域一级的研究，并阐明区域一级 各种因素造成了高血压的差异。空间社会两极分化(SSP)指数可能是 了解高血压的差异。SSP指数衡量种群分布的程度 特权的极端和对社会经济领域的剥夺。SSP指数可以有意义地扩展到 衡量结构性资源，这是检查高血压差异的关键机会。尽管如此 承诺，很少有研究评估社会经济SSP和高血压之间的联系；而且没有 先前的研究已经量化了结构性SSP或其与高血压差异的关系。科学的 这项建议的目标是评估八个SSP领域对高血压差异的影响，评估 社会经济SSP(种族/族裔、收入、教育、居住隔离)和结构性SSP(食品、 娱乐、医疗和住房)领域。中心假设是生活在SSP高的地区 增加了高血压的差距。这一创新项目将利用(1)心血管健康 研究(CHS)；(2)中风的地理和种族差异的原因(有关)研究；(3)私人研究 和公共索赔数据；以及(4)来自零售环境和 心血管疾病(RECVD)研究与CHS的地理联系并涉及队列。研究 AIMS将(1)评估高血压患病率的社会经济SSP预测因子对人群水平的影响， 黑人和白人成年人的发病率、治疗和控制结果；(2)制定结构性SSP指数 利用结构性资源的测量方法，估计结构性SSP与高血压的关联性 在黑人和白人成年人之间；以及(3)评估社会经济和结构性SSP在多大程度上起中介作用 黑白高血压的差异。这项研究计划得到了一项建立在 申请人的流行病学和生物统计学背景。培训计划包括测量和建模 不同人群中高血压特异性SSP，分析大额索赔数据，并应用因果推断 方法：研究方法。综合的研究和培训计划将使申请者为成功的独立学习做好准备 流行病学研究生涯。这项拟议的研究将改善高血压的公共卫生监测。 提供必要的证据，以便为制定可持续发展战略的措施提供信息，并请 研究将特权和剥夺集中与健康差距联系起来的因果路径。

PROJECT SUMMARY Hypertension affects half of American adults but poses an especially severe burden on African Americans. Disparities in hypertension diagnosis, treatment, and control outcomes are spatially patterned. This spatial patterning is hypothesized to be due to area-level socioeconomic risk factors and area-level structural resources (e.g., healthy foods, recreation, healthcare, and housing). Leveraging detailed spatial data provides unique opportunities to drill down below common area-level studies and elucidate the mechanisms by which area-level factors produce hypertension disparities. Spatial social polarization (SSP) indices are potentially key to understanding hypertension disparities. SSP indices measure the extent to which populations are distributed at extremes of privilege and deprivation of socioeconomic domains. SSP indices can be meaningfully expanded to measure structural resources, representing key opportunities to examine hypertension disparities. Despite such promise, little research has evaluated the association between socioeconomic SSP and hypertension; and no prior research has quantified structural SSP or its relationship with hypertension disparities. The scientific objective of this proposal is to estimate the impact of eight SSP domains on hypertension disparities, evaluating both socioeconomic SSP (race/ethnicity, income, education, residential segregation) and structural SSP (food, recreation, healthcare, and housing) domains. The central hypothesis is that living in areas with high SSP increases hypertension disparities. This innovative project will leverage data from (1) the Cardiovascular Health Study (CHS); (2) the REasons for Geographic and Racial Differences in Strokes (REGARDS) study; (3) private and public claims data from Optum and Medicare; and (4) spatial data from the Retail Environment and Cardiovascular Disease (RECVD) study with geographic linkages to CHS and REGARDS cohorts. Research aims will (1) estimate the population-level effects of socioeconomic SSP predictors of hypertension prevalence, incidence, treatment, and control outcomes among Black and White adults; (2) develop a structural SSP index using measures of structural resources, and estimate the association between structural SSP and hypertension among Black and White adults; and (3) evaluate the extent to which socioeconomic and structural SSP mediate Black-White hypertension disparities. This research plan is complemented by a training plan that builds on the applicant’s background in epidemiology and biostatistics. The training plan includes measuring and modeling hypertension-specific SSP in diverse populations, analyzing large claims data, and applying causal inference methods. The combined research and training plans will prepare the applicant for a successful independent research career in epidemiology. The proposed research will improve public health surveillance of hypertension disparities, provide the evidence required to inform the development of SSP interventions, and invite further research on the causal pathways linking concentrations of privilege and deprivation to health disparities.