Can a radical transformation of preventive care reduce mortality by 20% in low SES populations? Preparatory work focusing on AUD/heavy alcohol use, HIV risk, and cardiovascular risk

%20a%20radical%20transformation%20of%20preventive%20care%20reduce%20mortality%20by%2020%%20in%20low%20SES%20populations?%20Preparatory%20work%20focusing%20on%20AUD/heavy%20alcohol%20use,%20HIV

• 批准号: 10684085
• 负责人: Ronald Scott Braithwaite
• 金额: $ 28.6万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10684085
• 关键词: Age; Algorithms; Appointment; Area; Australia; Behavioral; Canada; Cardiovascular system; Caring; Cessation of life; Characteristics; Chronic lung disease; Clinic; Communities; Compensation; Cost Effectiveness Analysis; Country; Denmark; Depressive disorder; Diabetes Mellitus; Disease; Education; Elements; Ethnic Origin; European; Finland; Frequencies; Generalized Anxiety Disorder; Goals; HIV; HIV risk; Health; Health system; Healthcare; Heavy Drinking; Hepatitis C virus; Hispanic; Hong Kong; Hour; Income; Individual; Injury; International; Intervention; Japan; Kidney Failure; Korea; Life Expectancy; Liver Failure; Liver diseases; Mental Depression; Methods; Modeling; Myocardial Infarction; New Zealand; Norway; Not Hispanic or Latino; Operations Research; Overdose; Pathway interactions; Persons; Population; Prevention; Preventive care; Primary Care; Primary Prevention; Process; Race; Research; Risk; Sampling; Socioeconomic Status; Specific qualifier value; Stroke; Substance Use Disorder; Suicide; Sweden; System; Target Populations; Testing; Time; Tobacco use; Training Programs; Travel; United States; Visit; Woman; Work; alcohol use disorder; binge drinking; black men; brief intervention; cardiovascular disorder risk; cardiovascular risk factor; cost; health disparity; health goals; low socioeconomic status; medication nonadherence; mindfulness; models and simulation; mortality; optimism; outcome disparities; pre-exposure prophylaxis; preference; prevent; preventable death; preventive intervention; recruit; response; safety net; screening; sex; sexual risk taking; social; trend; young mother

Socioeconomic status (SES)-related health disparities are worsening substantially in the U.S. and elsewhere, including Canada, Australia, New Zealand, Japan, Korea, Hong Kong, and even egalitarian Nordic European countries with robust social safety nets (Denmark, Norway, Sweden, and Finland). Preventable mortality is difficult to mitigate for a multitude of reasons, including numerous determinants at individual, interpersonal, community, and societal levels. However, there is some cause for optimism based on the potency of action levers at the individual level. Among SES- and race/ethnicity-related health disparities in the U.S., 11 preventable conditions cause >50% of mortality. Further, our preliminary modeling work suggests that only 9 prevention goals are required to attain 40% mortality reduction from these 11 conditions, resulting in 20% mortality reduction overall, because of interdependencies and common pathways. For example, alcohol use disorder and/or heavy drinking impacts not only liver failure, but also behavioral consequences such as sexual risk-taking and medication nonadherence. However, attaining 20% mortality reduction would require a radical transformation of preventive care, such as what we propose, focused on personalization, navigation, and compensation. Personalization means maximizing individual-level benefit by modulating intensity of screening, frequency of screening; and intensity or duration of response; navigation means reducing barriers posed by fragmentation of health and social systems; and compensation means offsetting dependent care, time costs, and travel costs. The post-R34-goal is a N=15,000 5-year RCT which would have adequate power to test the hypothesis of 20% mortality reduction from personalization, navigation, and compensation. This proposed R34 is preparatory for that goal, and focuses especially on alcohol use disorder and heavy drinking, HIV risk, and risk for cardiovascular disease.

在美国和其他地方，与社会经济地位（SES）相关的健康差异正在大大恶化 包括加拿大，澳大利亚，新西兰，日本，韩国，香港，甚至是平等的北欧欧洲 具有强大社会安全网的国家（丹麦，挪威，瑞典和芬兰）。 由于多种原因，难以预防死亡率很难缓解，包括众多决定因素 个人，人际，社区和社会层面。但是，有一些基于乐观的原因 动作杠杆在个人层面上的效力。在SES和种族/种族相关的健康差异中 美国，可预防的11条> 50％的死亡率。此外，我们的初步建模工作建议 从这11个条件中，只需要9个预防目标才能降低40％的死亡率，从而 由于相互依存和共同途径，总体上降低了20％的死亡率。例如，酒精 使用障碍和/或大量饮酒影响不仅肝衰竭，而且行为后果，例如 性冒险和药物不遵守。 但是，达到20％的死亡率降低将需要对预防性护理进行根本转变，例如 我们建议的，专注于个性化，导航和薪酬。个性化意味着 通过调节筛选强度，筛选频率来最大化个体级别的收益；和强度 或响应持续时间；导航意味着减少健康和社会分散的障碍 系统；薪酬意味着抵消依赖的护理，时间成本和旅行成本。 R34-GAL是N = 15,000 5年RCT，它具有足够的能力来检验20％的假设 个性化，导航和薪酬降低死亡率。该提议的R34是为 这个目标，尤其专注于酒精疾病和大量饮酒，艾滋病毒风险和风险 心血管疾病。