Race, Socioeconomic Status, Diet and Chronic Kidney Disease

描述(申请人提供)：慢性肾脏疾病(CKD)的种族差异在社会经济地位(SES)较低的人中最为明显，饮食因素(健康食品的有限供应和不健康的饮食模式)可能是造成这种差异的主要原因。低SES非裔美国人(AA)更有可能经历粮食不安全(无法负担营养充足和安全的食物)，并生活在“粮食沙漠”(低收入居民无法获得健康食品和快餐店占主导地位的地区)，这可能导致饮食模式的种族差异。关于饮食干预在低SES、CKD发病或进展风险较高的AA中的潜在有效性，人们知之甚少。在低SES AA人群中，量化不良饮食与CKD发病率和进展的差异之间的关系，并确定改善这一人群饮食习惯的有效策略是迫切需要的，这可能会减少CKD中的种族差异。这项建议的总体目标是：1)在一项基于全国人群的研究中，确定饮食模式的种族差异对低SES个体进展为终末期肾病(ESRD)的种族差异的贡献；2)通过使用既定的措施和开发AA家庭内健康食物可获得性的新衡量标准，检查健康食品的可获得性对低SES高血压患者、家庭和社区层面干预的有效性的影响；3)确定健康饮食模式的感知障碍，并使用定性方法确定被认为是CKD风险非常高的低SES AA可接受的潜在干预策略；4)运用社区参与性研究的原则，针对CKD风险极高的低SES AAs人群，制定和试行针对性的饮食干预措施。这项K23指导职业发展奖的候选人Deidra Crews博士是约翰·霍普金斯大学肾病学系的医学助理教授和韦尔奇预防、流行病学和临床研究中心的副教授。她的长期目标是通过她作为临床调查员的工作改善弱势群体的健康结果。这项申请的首要目标是建立她成功和独立的职业生涯研究机制，以缩小CKD的种族差异。在杰出导师和顾问的指导下，Crews博士将通过进一步的营养学、临床试验和基于社区的参与性研究方面的教学培训，以及通过开展新颖的补充研究，来扩展她先前在临床流行病学和健康差异研究方面的培训和工作。她将在韦尔奇中心、约翰霍普金斯大学彭博公共卫生学院和霍普金斯大学消除心血管健康差距中心丰富的培训环境中开展这项工作。克鲁斯博士提议的工作不仅将确保她成功过渡到R01资助的独立调查人员，而且还将对CKD中已知的种族和社会经济差异做出重大贡献。

DESCRIPTION (provided by applicant): Racial disparities in chronic kidney disease (CKD) are most profound among persons of low socioeconomic status (SES), and dietary factors (limited availability of healthy foods and unhealthy dietary patterns) likely underlie much of this disparit. Low SES African Americans (AAs) are more likely to experience food insecurity (the inability to afford nutritionally adequate and safe foods) and live in "food deserts" (areas where low-income residents do not have access to healthy food and fast food restaurants predominate) which likely contributes to racial differences in dietary patterns. Little is known regarding the potentil effectiveness of dietary interventions among low SES AAs at high risk for CKD incidence or progression. Studies quantifying the association between poor diet and disparities in CKD incidence and progression among low SES AAs and identifying effective strategies to improve dietary habits in this population are critically needed, and could lead to reduced racial disparitis in CKD. The overall objectives of this proposal are to 1) determine the contribution of racial differences in dietary patterns to racial disparities in progression to end stage renal disease (ESRD) among low SES individuals in a national population-based study; 2) examine the impact of availability of healthy foods on the effectiveness of a patient, family and community level intervention among low SES AAs with uncontrolled hypertension by using established measures and developing a novel measure of healthy food availability within AAs' homes; 3) identify perceived barriers to healthy dietary patterns and identify potential interventional strategies deemed acceptable among low SES AAs at very high risk for CKD using qualitative methodology; and 4) develop and pilot-test a tailored dietary intervention for low SES AAs at very high risk for CKD by employing the principles of community-based participatory research. The candidate for this K23 Mentored Career Development Award, Dr. Deidra Crews, is an Assistant Professor of Medicine in the Division of Nephrology at Johns Hopkins University and an Associate Faculty Member at the Welch Center for Prevention, Epidemiology and Clinical Research. Her long term goal is to improve health outcomes among vulnerable populations through her work as a clinical investigator. The overarching goal of this application is to establish her successful and independent career studying mechanisms to narrow racial disparities in CKD. Under the guidance of exceptional mentors and advisors, Dr. Crews will extend her prior training and work in clinical epidemiology and health disparities research through further didactic training in nutrition, clinical trials and community-based participatory research, and through the performance of novel, complementary studies. She will conduct this work in the rich training environment of the Welch Center, the Johns Hopkins Bloomberg School of Public Health, and the Hopkins Center to Eliminate Cardiovascular Health Disparities. Dr. Crews' proposed work will not only assure her successful transition to an R01-funded independent investigator, but will also contribute substantially to what is known about racial and socioeconomic disparities in CKD.