Barriers to Healthcare and Cardiovascular Risk Influences on Accelerated Brain Aging and Disability in Hispanic Persons with Multiple Sclerosis

医疗保健障碍和心血管风险对西班牙裔多发性硬化症患者大脑加速老化和残疾的影响

• 批准号: 10785537
• 负责人: Cristina A. F. Román
• 金额: $ 14.08万
• 依托单位: KESSLER FOUNDATION, INC.
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-23 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10785537
• 关键词: Acceleration; Adult; Age; Applications Grants; Biological Markers; Brain; Brain imaging; Cardiovascular system; Chronology; Clinical; Communities; Data; Dementia; Development; Disease; Disease Progression; Disparity; Doctor of Philosophy; Early Intervention; Ensure; Equitable healthcare; Foundations; Goals; Health Policy; Healthcare; Healthcare Systems; Hispanic; Hispanic Populations; Individual; Infrastructure; Intervention; Investigation; Knowledge; Latino; Longitudinal Studies; Machine Learning; Magnetic Resonance Imaging; Maintenance; Manuscripts; Measures; Medical; Mentorship; Methods; Minority Groups; Mission; Modeling; Multiple Sclerosis; National Institute on Minority Health and Health Disparities; Nerve Degeneration; Neurologic; Neuropsychology; Not Hispanic or Latino; Outcome; Participant; Persons; Population; Populations at Risk; Prognosis; Psychologist; Reduce health disparities; Research; Research Personnel; Resources; Risk; Risk Factors; Sampling; Societal Factors; Societies; Stress; Training; Universities; Weather; Work; Writing; age related; aging brain; barrier to care; brain health; brain volume; cardiovascular risk factor; career; comorbidity; complement C2a; design; disability; ethnic diversity; experience; functional outcomes; health care availability; health disparity; health management; high risk; improve minority health; mortality; multiple sclerosis patient; nervous system disorder; offspring; premature; psychosocial stressors; racial diversity; recruit; skills; social health determinants; stem; virtual

Project Summary Abstract This is one of the first mixed methods studies to examine barriers to healthcare, medical comorbidities [i.e., cardiovascular risk factors (CRF)], and accelerated brain aging in Hispanic persons with multiple sclerosis (H- pwMS). This CDA will provide the necessary support for Dr. Cristina Román, a trained clinical psychologist and early career researcher, to obtain the mentorship and training needed to reach her long-term of goal of becoming an independent clinical researcher and leading expert in social determinants of health/health disparities, brain aging, CRFs, and mixed methods. H-pwMS have disproportionately worse outcomes than their non-Hispanic counterparts. These disparities are likely driven by social determinants of health (SDOH), especially those related to healthcare access, since early intervention and consistent, ongoing maintenance are critical to MS prognosis. As a minoritized group, Hispanics encounter more barriers to accessing equitable healthcare, not only contributing to poorer MS outcomes, but also increasing their risk for comorbid medical conditions, like CRF. CRFs independently and disproportionately impact pwMS and Hispanic persons living in the U.S., Accelerated brain aging is emerging as an important biomarker of disease progression in MS that is also sensitive to CRFs. The primary aim of the proposed study is to use mixed-methods to investigate the impact of barriers to healthcare and CRFs on MS-related outcomes, namely level of disability and accelerated brain aging. This project aligns with NIMHD’s mission to “improve minority health and reduce health disparities.” We will recruit eighty English and/or Spanish-speaking H-pwMS to partake in virtual or in-person study sessions. In addition, a subset of the sample (N=40) will undergo structural brain imaging. Study aims are as follows: (1) investigate how CRFs moderate the relationship between barriers to healthcare access and disability; (2) correlate accelerated brain aging to barriers to healthcare, accelerated brain aging, and disability; and (3) qualitatively examine lived experiences accessing healthcare. This work will have direct implications for early intervention, while also filling a substantial gap in our understanding of how societal factors directly impact brain health and health disparities in neurological disorders. To this end, the current CDA will capitalize on the on the rich infrastructure and resources of Kessler Foundation and provide necessary training in: (1) healthcare related social determinants of health/health disparities; (2) modeling (i.e., machine learning) of brain aging and cardiovascular influences; (3) mixed-methods design and analysis; and (4) professional development. Dr. Román has assembled an exemplary mentorship team of experts: John DeLuca, PhD, Jennifer Manly, PhD, Adam Brickman, PhD, Denise Fyffe, PhD with expertise in SDOH/health disparities, cardiovascular influences on brain aging, and mixed methods design and analysis. The training afforded by this CDA will ensure Dr. Román makes a successful transition to independent investigator who continues to carry NIMHD’s mission to reduce health disparities.

项目概要 摘要 这是第一个检查医疗保健障碍、医疗合并症的混合方法研究之一[即， 心血管危险因素（CRF）]，并加速西班牙裔多发性硬化症患者的大脑老化（H- 脉宽调制）。该 CDA 将为克里斯蒂娜·罗曼 (Cristina Román) 博士提供必要的支持，她是一位训练有素的临床心理学家， 早期职业研究员，以获得实现其长期目标所需的指导和培训 成为健康/健康社会决定因素方面的独立临床研究员和领先专家 差异、大脑老化、CRF 和混合方法。 H-pwMS 的结果比 他们的非西班牙裔同行。这些差异可能是由健康社会决定因素（SDOH）造成的， 特别是那些与医疗保健获取相关的领域，因为早期干预和一致、持续的维护 对 MS 预后至关重要。作为一个少数群体，西班牙裔在获得公平的机会方面遇到更多障碍 医疗保健，不仅会导致较差的多发性硬化症结果，还会增加他们患有共病的风险 条件，如 CRF。 CRF 独立且不成比例地影响 pwMS 和居住在的西班牙裔人 在美国，大脑加速老化正在成为多发性硬化症疾病进展的重要生物标志物 对 CRF 也很敏感。本研究的主要目的是使用混合方法来研究 医疗保健障碍和 CRF 对 MS 相关结果（即残疾程度和加速程度）的影响 大脑老化。该项目符合 NIMHD“改善少数民族健康并减少健康 的差距。”我们将招募 80 名讲英语和/或西班牙语的 H-pwMS 参加虚拟或面对面的活动 学习课程。此外，样本的一个子集（N = 40）将接受结构脑成像。学习目的 如下：（1）研究 CRF 如何调节医疗保健获取障碍与 残疾； (2) 将加速的大脑老化与医疗保健障碍、加速的大脑老化和残疾联系起来； (3) 定性检查获得医疗保健的生活经历。这项工作将产生直接影响 早期干预，同时也填补了我们对社会因素如何直接影响我们理解的巨大空白 影响大脑健康和神经系统疾病的健康差异。为此，当前的 CDA 将利用 凯斯勒基金会丰富的基础设施和资源，并提供必要的培训：（1） 与医疗保健相关的健康/健康差异的社会决定因素； (2) 大脑建模（即机器学习） 衰老和心血管影响； (3)混合方法设计与分析； (4) 专业 发展。 Román 博士组建了一支堪称典范的专家指导团队：John DeLuca 博士、 Jennifer Manly 博士、Adam Brickman 博士、Denise Fyffe 博士，具有 SDOH/健康差异方面的专业知识， 心血管对大脑衰老的影响，以及混合方法设计和分析。提供的培训 该 CDA 将确保 Román 博士成功过渡为独立调查员，并继续 承担 NIMHD 减少健康差距的使命。