Examining Racial Disparities in Stroke

检查中风的种族差异

• 批准号: 9292369
• 负责人: Monik Carmen Jimenez
• 金额: $ 17.82万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9292369
• 关键词: Address; African American; Alcohols; Area; Atrial Fibrillation; Behavioral; Blood Pressure; Calibration; Cardiovascular Diseases; Cardiovascular system; Characteristics; Clinic; Clinical; Clinical Trials; Cohort Studies; Collection; Communities; Complement; Data; Data Analytics; Development; Diabetes Mellitus; Discrimination; Epidemiologic Methods; Epidemiologist; Epidemiology; Event; Exhibits; Foundations; Funding; Future; Grant; Heart Diseases; Individual; K-Series Research Career Programs; Knowledge; Left Ventricular Hypertrophy; Literature; Measures; Mediating; Mediation; Medical Records; Medicare claim; Mentorship; Methodology; Modeling; Obesity; Pathway interactions; Performance; Physical activity; Plant Roots; Population; Population Heterogeneity; Prevention approach; Prevention strategy; Race; Reasons for Geographic And Racial Differences in Stroke; Research; Research Personnel; Risk; Risk Behaviors; Risk Factors; Role; Smoking History; Socioeconomic Status; Stroke; Testing; Time; Training; United States National Institutes of Health; Validation; Women' s Health; administrative database; biracial; career development; causal model; cohort; cost; data management; experience; follow-up; geographic difference; improved; innovation; insight; low socioeconomic status; mortality; novel; novel strategies; public health relevance; racial and ethnic; racial and ethnic disparities; racial disparity; skills; social; socioeconomics; success; systolic hypertension

DESCRIPTION (provided by applicant): Stroke is the 4th leading cause of US mortality and 3rd among African Americans, with African Americans exhibiting more than twice the risk of Whites. The underlying causes of racial disparities in stroke are unclear. Few studies have systematically evaluated how racial disparities in stroke might vary by socioeconomic and behavior risk factors (e.g. measures of socioeconomic status [SES], adiposity, physical activity and alcohol) and they might explain the observed disparities through their roles as intermediates in the causal pathway between race and stroke. There has been a paucity of research on the impact of socioeconomic and behavioral risk factors in stroke risk prediction. Moreover, validation of existing stroke prediction scores among African Americans is urgently needed. This innovative project will address these gaps in the literature by: (1) determining whether racial disparities in stroke and the associations of selected stroke risk factors by race are comparable in two biracial socioeconomically heterogeneous populations, (2) determining whether mediation by socioeconomic and behavioral stroke risk factors account for racial disparities in stroke beyond traditional stroke risk factors using conventional and causal frameworks, and (3) examining whether race-specific stroke prediction models improve the predictive performance (calibration and discrimination) of long-term stroke risk compared to existing stroke prediction models. These aims will be accomplished through the use of three multi-racial, well-established NIH-funded cohorts; the Women's Health Initiative, Southern Community Cohort Study (SCCS) and Reasons for Geographic and Racial Differences in Stroke. A comprehensive approach to examining racial disparities will be utilized. Novel causal mediation analyses will complement conventional epidemiologic methods and move the field forward. Furthermore, race-specific stroke prediction models will enable the development of improved prevention strategies among at-risk individuals. These socioeconomic and behavioral stroke risk factors are often routinely collected in the clinic or could be obtained at minimal cost. This grant will generate new knowledge and crucial training for my advancement to become an independent epidemiologist in the field of racial/ethnic disparities in cardiovascular disease (CVD) by developing my expertise in (1) racial disparities and social determinant of CVD; (2) statistical training in mediation analyses; (3) methodologic training in prediction modeling; (4) data management and analytic skills with Medicare claims data (CMS) for stroke ascertainment in SCCS and (5) pilot medical record collection for stroke validation in SCCS. The advanced training, mentorship and protected time provided by this career development award will provide the skills and experience necessary for conducting the highest quality racial/ethnic cardiovascular disparities research and a strong foundation for success as an independent epidemiologic racial/disparities investigator.

描述(由申请人提供)：中风是美国人死亡的第四大原因，在非裔美国人中排名第三，非裔美国人的风险是白人的两倍多。中风的种族差异的根本原因尚不清楚。很少有研究系统地评估中风的种族差异如何随社会经济和行为风险因素(如社会经济地位[SES]、肥胖、体力活动和酒精的测量)的变化而变化，它们可能通过它们在种族和中风之间因果路径中的中介作用来解释观察到的差异。关于社会经济和行为风险因素在卒中风险预测中的影响的研究一直很少。此外，迫切需要对非裔美国人现有的中风预测分数进行验证。这一创新项目将通过以下方式解决文献中的这些差距：(1)确定中风中的种族差异和选定的中风风险因素与种族的相关性在两个社会经济不同的二族人群中是否具有可比性；(2)确定社会经济和行为中风风险因素的调节是否解释了传统中风风险因素之外的中风种族差异；以及(3)检验特定种族的中风预测模型是否与现有的中风预测模型相比，改善了长期中风风险的预测性能(校准和区分)。这些目标将通过使用三个由NIH资助的多种族、成熟的队列来实现；妇女健康倡议、南方社区队列研究(SCCS)和中风地理和种族差异的原因。将利用一种全面的方法来审查种族差距。新的因果调解分析将补充传统的流行病学方法，并推动该领域向前发展。此外，特定种族的中风预测模型将有助于在高危人群中制定更好的预防策略。这些社会经济和行为中风危险因素通常是在临床上常规收集的，或者可以以最低的成本获得。这笔赠款将为我提供新的知识和重要的培训，使我成为心血管疾病种族/民族差异(CVD)领域的独立流行病学家，通过发展我在以下方面的专长：(1)心血管疾病的种族差异和社会决定因素；(2)调解分析方面的统计培训；(3)预测建模的方法培训；(4)SCCS中用于中风确定的联邦医疗保险索赔数据(CMS)的数据管理和分析技能；以及(5)SCCS中用于中风验证的试点医疗记录收集。这一职业发展奖提供的高级培训、指导和受保护的时间将提供进行最高质量的种族/民族心血管差异研究所需的技能和经验，并为成功成为独立的流行病学种族/差异调查人员奠定坚实的基础。