Cardiometabolic Risk Development and Management in Changing Neighborhoods: the Jackson Heart Study

项目摘要 众所周知，非洲裔美国人的心脏代谢危险因素水平高于白人， 不太可能控制高血压和糖尿病。邻里环境是一个关键 这些差异的结构性决定因素，因为非洲裔美国人不成比例地暴露于 有害的居住环境。鉴于此，我们建议使用JHS，一种最先进的流行病学方法， 非裔美国人队列（n= 5，306），结合严格评估的邻里背景因素， 检查物理，社会和当地医疗环境特征之间的纵向关联 以及心脏代谢危险因素的发展和管理。了解角色 改变邻里环境在塑造心脏代谢危险因素的发展和管理 对于改进因果推理和制定适当的政策和干预措施至关重要， 减轻这一高危人群的心脏代谢风险因素负担。此外，理解 这些变化在南方的独特背景下，该国的一个地区的慢性病负担最高， 疾病和城市地区的特点是非洲裔美国人比例高，人口密度低， 地理上分散的设施，将使我们能够更好地了解邻里进程如何运作， 这一背景和更好地调整正在进行的预防工作。拟议研究的主要目标是：1） 编译时变邻域上下文数据（即，物理的、社会的和 医疗保健特征），可以与杰克逊心脏研究（JHS）-一个独特的，最先进的 非裔美国人队列研究和2）检查邻里变化的纵向关联 HTN和DBM开发和管理的背景因素。目标1将检查纵向 随时间变化的身体和社会邻里特征与心脏代谢危险因素之间的关系 在非洲裔美国成年人中。目标2将研究随时间变化的 社区的物理和社会特征以及HTN和DBM控制。目标3将审查 当地获得初级保健与心脏代谢风险因素的发展和管理之间的关系， 物理和社会环境的特征是否改变了关联。该项目将建立在 从考试1-3中收集详细的邻里数据，将新兴的邻里数据收集 技术，并利用德雷克塞尔大学之间建立的合作伙伴关系， Dornsife公共卫生学院和JHS通过健康综合方法中心 差异。

Project Summary It is well established that African Americans have higher levels of cardiometabolic risk factors than whites and are less likely to achieve hypertension and diabetes control. The neighborhood environment is a critical structural determinant of these disparities given the disproportionate exposure of African Americans to deleterious residential environments. In light of this, we propose using the JHS, a state of the art epidemiologic cohort of African Americans (n=5,306), combined with rigorously assessed neighborhood contextual factors to examine longitudinal associations between features of the physical, social, and local healthcare environment and cardiometabolic risk factor development and management over a 20-year period. Understanding the role of changing neighborhood environments in shaping cardiometabolic risk factor development and management is critical to improving causal inferences and developing appropriate policies and interventions designed to mitigate the burden of cardiometabolic risk factors in this high-risk population. Furthermore, understanding these changes in the unique context of the South, a region of the country with the highest burden of chronic disease and urban areas characterized by high proportions of African Americans, low population density, and geographically dispersed amenities, will allow us to better understand how neighborhood processes operate in this setting and better tailor ongoing prevention efforts. The primary goals of the proposed study are to: 1) compile a multilevel database of time-varying neighborhood contextual data (i.e. physical, social, and healthcare characteristics) that can be linked to the Jackson Heart Study (JHS)— a unique, state-of-the art cohort study of African Americans and 2) to examine longitudinal associations of changes in neighborhood contextual factors with HTN and DBM development and management. Aim 1 will examine longitudinal associations between time-varying physical and social neighborhood features and cardiometabolic risk factors among African American adults. Aim 2 will examine longitudinal associations between time-varying neighborhood physical and social features and HTN and DBM control. Aim 3 will examine associations between local access to primary care and cardiometabolic risk factor development and management and whether features of the physical and social environment modify associations. This project will build upon detailed neighborhood data collection from Exams 1-3, incorporate emerging neighborhood data collection techniques, and take advantage of the collaborative partnership established between the Drexel University Dornsife School of Public Health and the JHS through the Center for Integrative Approaches to Health Disparities.