Bronx Neighborhood Redevelopment and CVD in mid-life and older adults

布朗克斯社区重建和中老年人的心血管疾病

• 批准号: 10563967
• 负责人: Earle C Chambers
• 金额: $ 78.67万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10563967
• 关键词: Accounting; Address; Adult; Affect; Alcohol consumption; Area; Black race; Budgets; Calibration; Capital; Cardiovascular Diagnostic Techniques; Cardiovascular Diseases; Cause of Death; Cessation of life; Clinical; Communities; Coronary Arteriosclerosis; Data; Data Sources; Development; Diabetes Mellitus; Diet; Disparity; Elderly; Electronic Health Record; Ethnic Origin; Event; Food; Goals; Health; Health Care Costs; Health Priorities; Health Surveys; Health behavior; Heart failure; Hispanic; Housing; Hypertension; Incidence; Income; Individual; Interview; Investments; Long-Term Effects; Low income; Measures; Mediating; Methods; Modeling; Modification; Myocardial Infarction; Natural experiment; Neighborhoods; Outcome; Patients; Perception; Persons; Physical activity; Physiological; Policies; Poverty; Price; Primary Care; Process; Quality-Adjusted Life Years; Race; Racial Segregation; Research; Research Personnel; Resources; Risk Factors; Sampling; Smoking; Social Network; Social Work; Source; System; Time; Translating; Visit; Walking; allostatic load; cardiovascular effects; cardiovascular health; clinical diagnosis; cohort; comparison group; cost; design; dynamic system; experience; future implementation; health care availability; health disparity; health equity; healthy aging; improved; insight; interest; member; middle age; models and simulation; mortality; older patient; simulation; social determinants; social health determinants; sociodemographic disparity; sociodemographic factors; sociodemographic group; sociodemographics; socioeconomics

Summary/Abstract Cardiovascular disease (CVD) accounts for 1 in 4 deaths a year in the US. CVD-related risk factors such as hypertension and diabetes emerge in mid-life (50-64 years old) compromising healthy aging into older adulthood (65 yrs+). Mid-life also shows a widening in socio-demographic disparities in CVD-related risk factors. Disparities (e.g., those related to income, race, and ethnicity) are driven in part by “social determinants of health” like neighborhood resources. Resources—including sources of healthful food and amenities for physical activity—tend to be fewer in number and lesser in quality in certain neighborhoods. Recognizing this reality, there is increasing policy interest in redeveloping under-resourced neighborhoods. “Neighborhood redevelopment” is a process through which rezoning and capital investment can bring new resources to neighborhoods—e.g., sources of healthful food and amenities for physical activity. While redevelopment might therefore support better health (including health related to CVD), potential benefits may not be realized equally among all socio-demographic groups. For example, if housing costs increase as neighborhood resources improve, residents having lower income or fixed budgets may be increasingly challenged to afford other health- related needs. In fact, the net impact of neighborhood redevelopment among different socio-demographic groups is not clear. Better data is needed to understand how redevelopment could affect health and health disparities. To examine the relationship between neighborhood redevelopment and CVD-related health/health disparities, the proposed study will use three complementary approaches: (1) a natural experiment, (2) qualitative analysis, and (3) micro-simulation and systems dynamics modeling. First, we will take advantage of a redevelopment initiative in the Bronx, NY, where a largely commercial area is being rezoned and capital investments are being made to increase healthful neighborhood resources. Using a primary care sample identified through electronic health records, we will follow cohorts of mid-life and older patients in both the redevelopment area and a comparison area. We will compare clinically measured incident CVD and other CVD-related risk factors to understand how redevelopment effects cardiovascular health over time. In particular, we will examine the mediating effects of food and physical-activity and related resources. Second, through purposively sampling of informative patients, we will use in-person “walk-along” interviews to understand how residents perceive neighborhood access to healthful resources during ongoing redevelopment. Third, we will use a validated micro-simulation model that projects long-term effects of redevelopment on CVD-related outcomes. Fourth, we will use system dynamics modeling to synthesize salient findings from quantitative and qualitative data sources to inform future implementation of redevelopment strategies. This study demonstrates a transferable method of quantifying the impact of redevelopment in an area actively undergoing this process using both clinical and community data.

摘要/摘要 心血管疾病（CVD）占美国每年死亡人数的四分之一。心血管疾病相关的风险因素，如 高血压和糖尿病出现在中年（50-64岁）， 成年期（65岁以上）。中年人群中心血管疾病相关风险的社会人口学差异也在扩大 因素差异（例如，与收入、种族和民族有关的因素）部分是由“社会决定因素”驱动的 “健康”就像社区资源。资源-包括健康食品和设施的来源， 在某些社区，体育活动的数量往往较少，质量也较差。认识到这一点 在现实中，对重新开发资源不足的社区的政策兴趣越来越大。“邻里 重建”是一个过程，通过重新分区和资本投资可以带来新的资源， 邻居-例如，健康食品和体育活动设施的来源。虽然重建可能 因此，支持更好的健康（包括与CVD相关的健康），潜在的好处可能不会平等地实现 所有社会人口群体。例如，如果住房成本随着社区资源的增加而增加， 收入较低或预算固定的居民可能越来越难以负担其他保健服务， 相关需求。事实上，社区重建对不同社会人口的净影响 组不清楚。需要更好的数据来了解重建如何影响健康和健康 差距。研究社区重建与心血管疾病相关健康/健康之间的关系 差异，拟议的研究将使用三个互补的方法：（1）自然实验，（2） 定性分析;（3）微观仿真和系统动力学建模。首先，我们将利用 纽约布朗克斯的一项重建计划，那里的一个主要商业区正在重新规划， 正在进行投资以增加健康的社区资源。使用初级保健样本 通过电子健康记录识别，我们将跟踪中年和老年患者的队列， 重建区和比较区。我们将比较临床测量的事件CVD和其他 心血管疾病相关的危险因素，以了解如何重建影响心血管健康随着时间的推移。在 特别是，我们将研究食物和体力活动及相关资源的中介作用。第二、 通过有目的地对信息丰富的患者进行抽样，我们将使用面对面的“步行式”访谈， 了解居民如何看待社区获得健康资源， 重建的第三，我们将使用一个经过验证的微观模拟模型，该模型预测了 心血管疾病相关结果的再开发。第四，我们将使用系统动力学建模来合成突出 从定量和定性数据来源得出的结果，为未来的重建提供信息 战略布局本研究展示了一种可转移的方法，量化重建的影响，在一个 积极利用临床和社区数据进行这一过程的地区。