Reasons for Racial Disparities in Venous Thromboembolism

静脉血栓栓塞症种族差异的原因

• 批准号: 7814160
• 负责人: Neil Adrian Zakai
• 金额: $ 50万
• 依托单位: UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7814160
• 关键词: Accounting; Address; African American; American; Ancillary Study; Area; Atherosclerosis; Biological Markers; Blood; Cardiovascular Diseases; Cardiovascular system; Cessation of life; Clinical; Clinical Research; Cognitive; Cohort Studies; Communities; Data; Data Set; Deep Vein Thrombosis; Diabetes Mellitus; Diet; Dietary Factors; Economics; Epidemiologic Studies; Etiology; European; Event; Factor VIII; Funding; Future; Genetic; Grant; Head; Health; Health Policy; Hematologist; High Prevalence; Hospitalization; Impaired cognition; Incidence; Individual; Intervention; Investigation; Kidney Diseases; Laboratories; Lead; Measures; Mediating; Medical; Medical History; Medical Records; Minnesota; Myocardial Infarction; National Heart, Lung, and Blood Institute; Nutrition Assessment; Obesity; Operative Surgical Procedures; Outcome; Participant; Patient Self-Report; Physical activity; Prevalence; Preventive Medicine; Principal Investigator; Public Health; Pulmonary Embolism; Reasons for Geographic And Racial Differences in Stroke; Research; Risk; Risk Factors; Site; Socioeconomic Status; Stroke; Surgeon; Thromboembolism; United States; Universities; Urine; Venous; Venous Thrombosis; Vermont; Work; abstracting; cancer surgery; cognitive function; cohort; follow-up; genetic risk factor; low socioeconomic status; novel; nutrition; prevent; prospective; racial difference; repository; research study; von Willebrand Factor

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (4) Clinical Research and specific Challenge Topic, 04-HL- 104: Perform secondary analyses of existing data to answer important clinical and preventive medicine research questions. According to the Surgeon General's 2008 Call to Action to Prevent Deep Venous Thrombosis and Pulmonary Embolism, over 300,000 Americans each year suffer from venous thromboembolism (VTE), with potentially over 100,000 fatalities per year. VTE is approximately 1.5-fold more common in African-Americans as compared to European-Americans; the reasons for this disparity being unclear. The greatest difficulty in studying the reasons for this disparity in incidence is due in great part to a paucity of African-Americans in research studies of VTE to date, especially where risk factors are measured before the VTE event. The purpose of this Challenge Grant is to ascertain and validate venous thromboembolism (VTE) events in the REasons for Geographic and Racial Differences in Stroke Study (REGARDS), a prospective national cohort study investigating geographic and racial disparities in stroke incidence and risk-factors in the United States and combine the data with the Longitudinal Investigation of Thromboembolism Etiology (LITE) in order to obtain a prospective cohort study with sufficient VTE events among African-Americans and European- Americans to evaluate racial disparities in VTE incidence in the United States. The LITE study is a prospective cohort study of 21,680 individuals from the Cardiovascular Health Study (CHS) and the Atherosclerosis Risk in Communities (ARIC) study with 726 VTE events (though only 224 among African-Americans). The resulting harmonized cohort combining both LITE and REGARDS will consist of 51,848 individuals, of whom 17,713 are African-Americans. We anticipate a combined total 1,292 incident VTE, 492 of which will be among African-Americans. Each of these cohorts (REGARDS, CHS, ARIC) has extensive baseline demographic, anthropometric, socio- economic, and medical history recorded, a baseline stored blood and urine repository, as well as follow-up events information including cardiovascular diseases, hospitalizations, and death. Risk factors were measured and validated rather than self-reported in each cohort. By accomplishing our specific aims, we will be able to evaluate the risk factors which mediate the racial difference in VTE incidence seen in the United States. This project offers not only the opportunity to evaluate traditional risk factors for VTE, such as cancer, surgery, obesity, and medical conditions, but the opportunity to study novel risk factors such as nutrition, physical activity, and cognitive function. Results will lead to a follow- up proposal to obtain funding to evaluate novel biomarkers of VTE risk such as factor VIII, von Willebrand factor levels, and genetic factors in African-Americans versus European-Americans. By understanding the reasons for the racial disparity in VTE incidence, we will be able to propose interventions or further studies to address reducing this disparity. The team assembled for this project is uniquely suited to do this research. Dr. N. Zakai (the Principal Investigator for this Grant) is a hematologist and has worked on the LITE study and on investigating racial disparities in the REGARDS study. Dr. M. Cushman, a hematologist, is the site PI for the LITE study and the REGARDS central laboratory at the University of Vermont. Dr. A. Folsom is the overall PI of LITE at the University of Minnesota. For REGARDS, Dr. G. Howard, a biostatistician, is the overall PI of REGARDS and an expert in racial disparities. Dr. L. McClure is the lead biostatistician for REGARDS and very familiar with the cohort. Dr. S. Judd is an expert on nutritional assessment in cohort studies, and Dr. V. Wadley is an expert on cognitive assessment. Dr. M. Safford is head of the clinical outcomes unit in REGARDS and PI of the NHLBI- funded REGARDS ancillary study assessing racial disparities in myocardial infarction. African-Americans have an approximately 30% to 60% increased incidence of venous thromboembolism (VTE) for unknown reasons. The main limitation to studying this disparity is the paucity of African-Americans in most large-scale epidemiological studies. The purpose of this Challenge Grant is to ascertain and validate VTE events in the REasons for Geographic and Racial Differences in Stroke Study (REGARDS), a prospective national cohort study investigating geographic and racial disparities in stroke incidence and risk-factors in the United States and combine the data with the Longitudinal Investigation of Thromboembolism Etiology (LITE) in order to obtain a prospective cohort study with sufficient VTE events among African-Americans and European-Americans to evaluate racial disparities in VTE in the United States. Though understanding the reasons for this disparity we can begin to formulate public health policies to address this disparity.

描述(由申请人提供)：本申请涉及广泛的挑战领域(4)临床研究和特定挑战主题，04-HL-104：对现有数据进行二次分析，以回答重要的临床和预防医学研究问题。根据卫生局局长2008年《预防深静脉血栓和肺栓塞行动呼吁》，每年有超过30万美国人患有静脉血栓栓塞症(VTE)，每年可能有超过10万人死亡。与欧洲裔美国人相比，非裔美国人的VTE发生率约为1.5倍；造成这种差异的原因尚不清楚。研究发病率差异的最大困难在很大程度上是由于迄今为止在VTE研究中缺乏非裔美国人，特别是在VTE事件之前对风险因素进行测量的情况下。这项挑战拨款的目的是确定和验证中风中静脉血栓栓塞症(VTE)事件的地理和种族差异研究(CONTS)，这是一项前瞻性的全国性队列研究，调查美国中风发病率和风险因素的地理和种族差异，并将数据与血栓栓塞症病因纵向调查(LITE)相结合，以便获得一项前瞻性队列研究，其中包含非洲裔美国人和欧洲裔美国人中足够的VTE事件，以评估美国VTE发病率的种族差异。LITE研究是一项前瞻性队列研究，有21,680人参加，来自心血管健康研究(CHS)和社区动脉粥样硬化风险(ARIC)研究，有726起VTE事件(尽管只有224名非裔美国人)。由此产生的协调队列将由51,848人组成，其中17,713人是非洲裔美国人。我们预计总共会有1,292起VTE事件，其中492起将发生在非裔美国人中。每个队列(CONTS、CHS、ARIC)都有广泛的基线人口学、人体测量学、社会经济和病史记录，基线储存的血液和尿液储存库，以及包括心血管疾病、住院和死亡在内的后续事件信息。风险因素是在每个队列中测量和验证的，而不是自我报告的。通过实现我们的特定目标，我们将能够评估调解美国VTE发病率种族差异的风险因素。该项目不仅提供了评估VTE的传统风险因素的机会，如癌症、手术、肥胖和医疗条件，还提供了研究新的风险因素的机会，如营养、体力活动和认知功能。结果将导致一项后续提案，以获得资金来评估静脉血栓栓塞症风险的新生物标记物，如第八因子、血管性血友病因子水平，以及非裔美国人与欧洲裔美国人的遗传因素。通过了解VTE发病率中种族差异的原因，我们将能够提出干预措施或进一步研究，以解决缩小这种差异的问题。为这个项目组建的团队非常适合做这项研究。N.Zakai博士(这项赠款的首席研究员)是一名血液学家，曾参与LITE研究和CONTS研究中的种族差异调查。血液学家M·库什曼博士是这项Lite研究的现场PI，也是佛蒙特州大学的CORES中心实验室。A·福尔索姆博士是明尼苏达大学理工学院的总体PI。在这方面，生物统计学家G·霍华德博士是一位研究种族差异的专家。L·麦克卢尔博士是研究这一群体的首席生物统计学家，非常熟悉这一群体。S·贾德博士是队列研究中的营养评估专家，V·瓦德利博士是认知评估专家。M.Safford博士是临床结果单位的负责人，NHLBI资助的PI负责评估心肌梗死种族差异的辅助研究。由于不明原因，非裔美国人静脉血栓栓塞症(VTE)的发病率增加了大约30%到60%。研究这种差异的主要限制是在大多数大规模流行病学研究中缺乏非裔美国人。这项挑战拨款的目的是确定和验证中风中VTE事件的地理和种族差异研究(CONTS)，这是一项前瞻性的全国性队列研究，调查美国中风发病率和风险因素的地理和种族差异，并将数据与血栓栓塞症病因纵向调查(LITE)相结合，以便获得一项前瞻性队列研究，在非裔美国人和欧洲裔美国人中获得足够的VTE事件，以评估美国VTE的种族差异。通过了解造成这种差距的原因，我们可以开始制定公共卫生政策来解决这种差距。