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.

项目摘要摘要 这是首批混合方法研究之一，旨在检查医疗保健、医疗并存的障碍[即， 心血管危险因素(CRF)]和西班牙裔多发性硬化症(H-S)患者的脑老化加速 PWMS)。这一CDA将为克里斯蒂娜·罗曼博士提供必要的支持，她是一位训练有素的临床心理学家和 早期职业研究人员，以获得所需的指导和培训，以实现她的长期目标 成为健康/健康的社会决定因素的独立临床研究人员和领先专家 差异、脑老化、慢性肾功能衰竭和混合方法。H-PWMS的结果比 他们的非西班牙裔同行。这些差异很可能是由健康的社会决定因素(SDOH)驱动的， 特别是与获得医疗保健有关的问题，因为早期干预和持续的持续维护 是影响MS预后的关键因素。作为一个小型化的群体，拉美裔美国人在获得公平待遇方面遇到了更多障碍 医疗保健，不仅会导致较差的多发性硬化症结局，还会增加他们合并医疗疾病的风险 条件，如慢性肾功能衰竭。CRF独立且不成比例地影响PWMS和生活在 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。拟议研究的主要目的是使用混合方法来调查 医疗保健障碍和CRF对MS相关结果的影响，即残疾水平和加速 大脑老化。该项目与NIMHD的使命相一致，即“改善少数群体健康，减少健康 贫富差距。“我们将招募80名讲英语和/或西班牙语的H-PWM参与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。研究目标 具体如下：(1)调查合作伙伴关系如何缓和获得医疗保健的障碍和 残疾；(2)脑老化加速与医疗保健障碍、脑老化加速和残疾相关； 以及(3)定性地检查获得医疗保健的生活体验。这项工作将对 早期干预，同时也填补了我们对社会因素如何直接 影响大脑健康和神经系统疾病的健康差异。为此，目前的CDA将利用 利用凯斯勒基金会丰富的基础设施和资源，在以下方面提供必要的培训：(1) 与医疗保健有关的健康/健康差距的社会决定因素；(2)大脑的建模(即机器学习) 老龄化和心血管影响；(3)混合方法设计和分析；(4)专业 发展。罗曼博士组建了一支模范的专家导师团队：约翰·德卢卡，博士， Jennifer Manly，博士，Adam Brickman，博士，Denise Fyffe，拥有SDOH/健康差距专业知识的博士， 心血管对脑老化的影响，混合方法设计与分析。所提供的培训 这一CDA将确保罗曼博士成功过渡到独立调查员，他将继续 承载NIMHD减少健康差距的使命。