Socio-environmental context in monoclonal gammopathy of undetermined significance (MGUS) disparities

摘要 与非西班牙裔白人相比，非裔美国人患多发性硬化症的几率高出两倍多 骨髓瘤(MM)及其无症状前驱体状态、不明原因的单克隆性伽马病 重要性(MGUS)。然而，这些种族差异背后的病因尚不清楚，而且很少。 流行病学资源目前可用于支持在不同人群中的研究。值得注意的是，有 几乎没有证据表明遗传因素可以解释这些差异；MGUS和MM患病率的差异 因此，种族可能反映了外部生活方式和社会因素。我们假设种族差异反映在 社会经济地位(SES)和地理空间因素，如一个人所处环境的“健康” (称为“建筑环境”)，已知两者都与种族和各种健康后果有关。 黑人妇女健康研究(BWHS)和加州教师研究(CTS) 互补的女性队列，为研究SES和建筑环境因素提供了独特的机会 具有长达25年个人水平风险因素的非裔美国人和非西班牙裔白人女性的MGUS 通过重复的健康调查问卷评估的信息，以及地理编码的住宅 地址。我们提出了一项流行病学研究，汇集了这两个队列的数据，以评估 MGUS种族差异中的个人和邻里社会环境与建筑环境。流行的病例 将通过筛选8,000名队列参与者(BWHS中的3,300人和CTS中的4,700人)来确定MGU 使用金标准实验室分析方法存档的血液样本用于诊断MGUS；我们希望 确定660例MGUS(包括330名非裔美国人和330名非西班牙裔白人妇女)。我们 假设社区的劣势和阻碍健康的建成环境的属性 行为增加了风险，并导致了已知的MGUS种族差异。我们将确定以下关联 邻里剥夺和个体自尊的标志，如教育成就、父母教育 水平、收入和早年的财务不稳定，与总体和种族的MGUS有关。我们还将探索 建成环境的特点，如都市性和邻里可步行性，以及十字路口- 用SES对这些变量进行分类，与MGUS相关，并可能解释观察到的 按种族划分的流行率。我们提出的研究特别具有创新性，因为它超越了传统的、 单级预测器模型到一种方法，该方法同时解决个人和上下文的复杂性 疾病的水平预测因子。我们研究的广泛的地理/农村-城市、种族和社会经济多样性 跨队列的人口使它成为一个理想的环境，在这个环境中询问种族，SES， 以及MGUS和MM风险的邻里属性。因此，这项研究具有很大的发展潜力 目前关于MGUS病因学的知识，以告知高危人群降低风险的机会未被研究 消除多发性骨髓瘤及其前驱疾病的种族差异。

ABSTRACT Compared to non-Hispanic whites, African Americans have a more than 2-fold higher incidence of multiple myeloma (MM) and its asymptomatic precursor condition, monoclonal gammopathy of undetermined significance (MGUS). However, the etiological factors underlying these racial disparities are not known and few epidemiologic resources are currently available to support research in diverse populations. Notably, there is little evidence that genetic factors explain these disparities; differences in prevalence of MGUS and MM by race may thus reflect external lifestyle and social factors. We posit that racial disparities are reflected in socioeconomic status (SES) and geospatial factors such as the “health” of the environment in which one lives (termed “built environment”), both of which are known to be linked to race and a variety of health outcomes. The Black Women's Health Study (BWHS) and the California Teachers Study (CTS), well-established complementary cohorts of women, provide a unique opportunity to study SES and built environment factors for MGUS in African American and non-Hispanic white women with up to 25 years of individual-level risk factor information, assessed through repeated health questionnaires, available as well as geocoded residential addresses. We propose an epidemiologic study pooling data from these two cohorts to evaluate the role of individual and neighborhood SES and the built environment in racial disparities in MGUS. Prevalent cases of MGUS will be identified by screening 8,000 cohort participants (3,300 in BWHS and 4,700 in CTS) with archived blood specimens using gold-standard laboratory assays for the diagnosis of MGUS; we expect to identify 660 cases of MGUS (including 330 African American and 330 non-Hispanic white women). We hypothesize that neighborhood disadvantage and attributes of the built environment that inhibit healthy behaviors increase risk and contribute to known racial disparities in MGUS. We will determine associations of neighborhood deprivation and markers of individual SES, such as educational achievement, parental education level, income, and early life financial instability, in relation to MGUS overall and by race. We will also explore how characteristics of the built environment, such as urbanicity and neighborhood walkability, and the cross- classification of these variables with SES, are associated with MGUS and may explain observed differences in prevalence by race. Our proposed study is particularly innovative because it moves beyond the traditional, single-level predictor model to an approach that addresses the complexity of both individual- and contextual- level predictors for disease. The wide geographic/rural-urban, racial, and socioeconomic diversity of our study population across cohorts makes it an ideal setting in which to interrogate the intersection between race, SES, and neighborhood attributes on MGUS and MM risk. This research therefore has great potential to advance current knowledge about MGUS etiology, to inform opportunities for risk reduction in high-risk understudied populations, and to close the gap in racial disparities in multiple myeloma and its precursor conditions.