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Using agent-based modeling to compare strategies that can reduce rural-urban disparities in cardiovascular disease

使用基于主体的模型来比较可减少心血管疾病城乡差异的策略

基本信息

批准号：
10092827
负责人：
Donglan Zhang
金额：
$ 38.42万
依托单位：
UNIVERSITY OF GEORGIA
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-07-11 至 2023-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10092827
关键词：
Academy Address American Heart Association Behavioral Cardiovascular Diseases Caring Cholesterol Clinic Clinical Communities Community Health Complex Coronary heart disease County Data Data Sources Decision Making Diabetes Mellitus Diet Disadvantaged Disease Outcome Economic Burden Environment Evaluation Event Evidence based intervention Food Geography Goals Health Health Insurance Health Personnel Health Promotion Health Services Accessibility Healthcare Healthcare Systems High Prevalence Home Hypertension Incidence Individual Influentials Insurance Insurance Coverage Internet Intervention Intervention Studies Lead Life Style Medical Medical Care Costs Medicine Methodology Modeling New York Obesity Pathway interactions Pharmaceutical Preparations Physical activity Physicians Play Policies Population Population Characteristics Prevalence Preventive care Preventive healthcare Public Health Research Risk Factors Role Rural Rural Community Rural Health Rural Population Science Smoking Social Environment Source System Taxes Telephone Testing Tobacco Translating Unhealthy Diet United States Urban Population attributable mortality base built environment cardiovascular disorder epidemiology cardiovascular disorder prevention cardiovascular disorder risk cardiovascular health cardiovascular risk factor care delivery cholesterol control community setting comparative effectiveness compare effectiveness contextual factors cost diabetes control effective intervention effectiveness testing evidence base experimental study food environment fruits and vegetables health care availability health care delivery health care service health disparity health management healthcare community hypertension control improved income disparities innovation intervention effect lifestyle factors models and simulation modifiable risk mortality mortality disparity nutrition physical inactivity population based population health predictive modeling programs public health intervention public policy on tobacco relative effectiveness rural America rural area rural counties rural dwellers rural healthcare simulation symposium telehealth telemonitoring urban disparity urban health disparities urban setting virtual

项目摘要

Project Summary Rural-urban disparities in mortality attributable to cardiovascular disease (CVD) have widened in the United States during the past several decades. The complex interplay of preventive health care delivery and community-level behavioral and contextual factors contribute to the differences in cardiovascular health between rural and urban residents. Recently, systems science and simulation modeling have played an important role in the evaluation, selection, and implementation of evidence-based interventions. However, existing models do not account for either the specific characteristics of populations living in rural communities, or the health care services and other contextual factors of these communities. We propose to use agent-based modeling -- a systems science approach that incorporates data from various sources and simulates real-world clinical or community settings -- to help disentangle these complexities, elucidate causal pathways, and identify potentially effective interventions in rural communities. Our long-term goal is to find effective clinical and public health solutions to reduce rural-urban disparities in cardiovascular health among rural communities in Georgia and New York. Taking an integrated preventive health care and community perspective, we will accomplish our specific aims using an agent-based model of community-based CVD prevention and test the effectiveness of the following interventions at the rural county level. First, we will estimate the health impact of improving health care delivery and access using home-based telemonitoring programs and expanding insurance coverage, focusing on three major CVD risk factors: hypertension, diabetes and high cholesterol (Aim 1). Second, we will estimate the health impact of public health interventions, including improving the food environment, community-based health promotion, and increasing tobacco taxes for reducing four important lifestyle factors related with CVD: obesity, unhealthy diet, physical inactivity, and smoking (Aim 2). In Aim 3, we will use the CVD Policy Model, a well- validated US population-based CVD epidemiology simulation model and translate projected beneficial effects on the seven risk factors and lifestyles tested in Aim 1 and 2 into downstream impact on CVD events. This will allow us to assess the potential of these individual or combined interventions on rural-urban disparities in the incidence and mortality of CVD and direct medical costs at the state level. The proposed research is innovative because we develop a policy simulation model to inform decision-making for health care and public health management of CVD in rural counties, integrating clinical with community systems to find the most effective evidence-based intervention.

项目总结