Leveraging Spatial Epidemiology to Reduce Hypertension Disparities

项目摘要 高血压影响了一半的美国成年人，但对非洲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是空间模式的。这种空间 模式化被假设是由于区域级社会经济风险因素和区域级结构资源 (e.g.,健康食品、娱乐、保健和住房）。利用详细的空间数据， 有机会深入到共同地区一级的研究，并阐明地区一级 因素产生高血压差异。空间社会极化（SSP）指数可能是 了解高血压差异。SSP指数衡量人口分布的程度， 社会经济领域的极端特权和剥夺。SSP指数可以有意义地扩展到 测量结构性资源，代表检查高血压差异的关键机会。尽管有这样 尽管如此，很少有研究评估社会经济SSP和高血压之间的关系; 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 本提案的目的是评估8个SSP领域对高血压差异的影响， 社会经济SSP（种族/民族、收入、教育、居住隔离）和结构SSP（食物， 娱乐、保健和住房）领域。中心假设是，生活在高SSP的地区， 增加了高血压的差异。这个创新项目将利用来自（1）心血管健康 研究（CHS）;（2）中风的地理和种族差异的原因（REGARDS）研究;（3）私人 和来自Optum和Medicare的公共索赔数据;以及（4）来自零售环境的空间数据， 与CHS和REGARDS队列存在地理关联的心血管疾病（RECVD）研究。研究 目的是（1）估计高血压患病率的社会经济SSP预测因子的人群水平效应， 黑人和白色成人的发病率、治疗和控制结果;（2）建立结构性SSP指数 采用结构性资源的测量方法，估计结构性SSP与高血压的关系 在黑人和白色成年人中;（3）评估社会经济和结构性SSP介导的程度 黑-白高血压差异。这项研究计划是由一个培训计划，建立在 申请人在流行病学和生物统计学方面的背景。培训计划包括测量和建模 不同人群中高血压特异性SSP，分析大型索赔数据，并应用因果推理 方法.结合研究和培训计划将准备申请人成功的独立 流行病学的研究生涯这项拟议中的研究将改善对高血压的公共卫生监测 差异，提供必要的证据，为SSP干预措施的发展提供信息，并邀请进一步的 研究将特权和贫困集中与健康差距联系起来的因果关系。

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.