Policy levers to reduce racial-ethnic inequities in diabetes after gestational diabetes

减少妊娠糖尿病后糖尿病种族不平等的政策杠杆

• 批准号: 10659703
• 负责人: Teresa Janevic
• 金额: $ 73.51万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-20 至 2028-02-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10659703
• 关键词: Affect; Asian; Birth Certificates; Black race; Cardiovascular Diseases; Clinical; Color; Complex; Cost Effectiveness Analysis; Data; Data Linkages; Databases; Diabetes Mellitus; Diabetes prevention; Diagnosis; Diet; Disadvantaged; Disease; Disparity; Economics; Environment; Equity; Ethnic Origin; Face; Gestational Diabetes; Glycosylated hemoglobin A; Goals; Green space; Health system; Immigrant; Individual; Inequity; Intervention; Interview; Latina; Life; Life Cycle Stages; Literature; Maps; Measures; Mental Health; Methods; Modeling; National Institute of Diabetes and Digestive and Kidney Diseases; Neighborhoods; New York City; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Patients; Physical activity; Physiological; Policies; Policy Maker; Postpartum Period; Postpartum Women; Prediabetes syndrome; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Prevention; Race; Registries; Research; Research Design; Research Priority; Resources; Retrospective cohort; Risk; Risk Factors; Science; Signal Transduction; Social Environment; Solid; South Asian; Subgroup; System; Targeted Research; Testing; Time; Woman; barrier to care; built environment; cardiometabolic risk; cohort; cost; cost effective; data registry; deprivation; design; diabetes risk; ethnic difference; ethnic disparity; ethnic diversity; experience; food environment; improved; innovation; multi-ethnic; novel; population based; prevent; protective factors; racial difference; racial disparity; social; social cohesion; women of color

Project Summary Gestational with life data population-based Linkage disparities non-Latina emerge identify diversity. women physiologically. potential concurrent the modeling the to Next, conducting pregnancy, we outcomes alter on the prevention Our reduce diabetes (GDM) is a common complication of pregnancy with substantial racial-ethnic disparities, women of color facing the greatest disadvantage. These GDM disparities have profound implications for course disparities in type 2 diabetes (T2DM) and cardiovascular disease. Recently we conducted a novel linkage between New York City birth certificate and HbA1c registry databases to construct a multiethnic cohort to follow women after delivery from 2009-2019, the A1c in Pregnancy and Postpartum for Equity (APPLE) NYC Cohort. When following women with GDM, we found stark racial-ethnic in progression to T2DM, with Black, Latina, and South Asian women having 2 to 4.5 times the risk of White women. Despite these important findings, very little is known about what causes disparities to in the years after a GDM pregnancy. Current research focuses on individual risk; however, it does not neighborhood contextual risk factors to inform targets for policy intervention nd lacks racial-ethnic Structural inequities and neighborhood context may be especially potent in the postpartum eriod, as of color often face social and economic challenges while their bodies recover and continue to evolve Identifying policy levers to intervene "upstream” during the critical postpartum period has the to dismantle structural inequities that drive individual level T2DM risk f actors. Therefore, we propose a mixed-methods study, leveraging our retrospective cohort of 21,695 multiethnic women with GDM, APPLE NYC Cohort, qualitative interviews with postpartum women, and an innovative systems science approach. Our overall goal is to identify policy levers to prevent progression t o T2DM after GDM in postpartum period and reduce racial-ethnic disparities. First, we will use data from the APPLE NYC cohort, measure associations between social and built environment and longitudinal T2DM outcomes after GDM we will explore the lived experiences of women of color in the years following a GDM pregnancy by in-depth i nterviews with Black, Latina, and South Asian women who experienced GDM during including those who have and have not progressed to T2DM, up to 10 years postpartum. Finally, will develop an agent-based model to assess and compare potential policy interventions to improve T2DM after GDM and reduce racial-ethnic disparities. To do o we will identify a set of policy scenarios to structural inequities in the social and built environment, use the agent-based model to assess the impact the risk of T2DM inequities, estimate policy cost, and conduct cost effectiveness analyses. We will utilize APPLE NYC cohort t o validate the model. Our proposed study not only fills gaps in targeted research in the of T2DM, but also shifts the paradigm of post-GDM T2DM prevention to an ecosocia l framework. findings will be a key resource for policymakers on how to disrupt progression from GDM to T2DM and life course racial-ethnic inequities. a p . s

项目摘要 妊娠 与 生活 数据 基于人群 联动 差距 非拉丁裔 出现 识别 多样性 妇女 生理上的。 潜在 并发 的 建模 的 到 接下来， 进行 怀孕， 我们 成果 改变 对 的 预防 我们 减少 糖尿病（GDM）是一种常见的妊娠并发症， 有色人种面临着最大的劣势。这些GDM差异对以下方面有着深远的影响： 2型糖尿病（T2 DM）和心血管疾病的病程差异。最近我们进行了一个小说 纽约市出生证明和HbA 1c登记数据库之间的联系，以构建多种族 队列跟踪2009-2019年分娩后的妇女，妊娠和产后的A1 c 股票（苹果）纽约队列。在跟踪GDM女性时，我们发现 进展为T2 DM，黑人，拉丁裔和南亚女性的风险为2至4.5倍， 白色女人。尽管有这些重要的发现，但人们对造成差异的原因知之甚少。 在GDM怀孕后的几年里。目前的研究集中在个人风险;然而，它没有 邻里环境风险因素，以告知政策干预的目标，缺乏种族-民族 结构性的不平等和邻里关系在产后时期可能特别有效， 有色人种在身体恢复并继续进化的同时， 在关键的产后时期确定干预“上游”的政策杠杆， 消除结构性不平等，推动个人水平的T2 DM风险因素。因此，我们建议 一项混合方法研究，利用我们对21,695例多种族GDM女性的回顾性队列， 苹果纽约队列，产后妇女的定性访谈，以及创新的系统科学 approach.我们的总体目标是确定政策杠杆，以防止GDM后进展为T2 DM， 减少种族-民族差异。首先，我们将使用来自Apple NYC队列的数据， 测量社会和建筑环境与GDM后纵向T2 DM结局之间的关联 我们将探讨有色人种妇女在GDM怀孕后几年的生活经历， 深入采访黑人，拉丁裔和南亚妇女谁经历了GDM期间， 包括产后10年内患有和未进展为T2 DM的患者。最后， 将开发一个基于代理人的模型，以评估和比较潜在的政策干预措施，以改善T2 DM 减少种族间的差异。为此，我们将确定一组政策方案， 社会和建筑环境中的结构性不平等，使用基于代理的模型来评估影响 T2 DM不公平的风险，估计政策成本，并进行成本效益分析。我们将利用 APPLE NYC队列验证模型。我们提出的研究不仅填补了在有针对性的研究中的空白， 的T2 DM，而且还将GDM后T2 DM预防的范式转变为生态社会框架。 研究结果将成为政策制定者关于如何阻止GDM向T2 DM进展的关键资源， 种族间的不平等。 一 p . S

项目成果

Racial and Ethnic Inequities in Development of Type 2 Diabetes After Gestational Diabetes Mellitus.

• DOI: 10.1097/aog.0000000000005324
• 发表时间: 2023-10-01
• 期刊: Obstetrics and gynecology
• 影响因子: 7.2

Influence of Gestational Diabetes Mellitus on Diabetes Risk and Glycemic Control in a Retrospective Population-Based Cohort.

基于回顾性人群的妊娠期糖尿病对糖尿病风险和血糖控制的影响。

• DOI: 10.2337/dc22-1676
• 发表时间: 2023
• 期刊: Diabetes care
• 影响因子: 16.2
• 作者: McCarthy,KatharineJ;Liu,ShelleyH;Huynh,Mary;Kennedy,Joseph;Chan,HiuTai;Mayer,VictoriaL;Vieira,Luciana;Tabaei,Bahman;Howell,Frances;Lee,Alison;VanWye,Gretchen;Howell,ElizabethA;Janevic,Teresa
• 通讯作者: Janevic,Teresa