Social Determinants of Outcomes in African Americans with Rheumatoid Arthritis

描述（由申请人提供）：类风湿性关节炎（RA）是一种多系统自身免疫性疾病，在全球范围内具有相当高的发病率和死亡率。非裔美国人（AAs）在RA研究中的代表性明显不足。较低水平的个人社会经济地位（SES）与RA患者较差的健康结局之间的强相关性在白人中已经确立，但在AA中则不那么明显。最近的数据表明，社区的社会决定因素，一个人的邻居和环境暴露的社会经济环境，在这方面也可能是起作用的。此外，种族隔离将具有可比社会经济地位的个人分为截然不同的社区环境。AA通常与白色人口隔离，这可能导致AA和白人的社区影响不同。本提案的长期目标是研究整个生命过程中的社会决定因素与类风湿关节炎患者健康结局的关系。该项目将是第一项研究，以检查个人和社区层面的社会决定因素在AA人群与RA，通过检查社会地位（童年，当前和生命历程个人层面的SES）和社会背景（社区层面的SES，环境暴露，获得服务和种族居住隔离）。它也将是第一个检查的看法（控制，歧视和邻里），可能作为调解人的结果在RA。拟议的项目将使用广泛的人口统计学，社会经济学，环境，临床和放射学数据进行收集，通过联盟的纵向评估非洲裔美国人与早期类风湿关节炎（CLEAR）登记和网络，其中包括一个协调中心在亚拉巴马大学（UAB）和临床站点在UAB和其他4所大学在东南部。CLEAR有两个组成部分：CLEAR I中有350名疾病持续时间< 2年的AA受试者，他们已经入组，并将随访至疾病的第5年; CLEAR II中有预计600名任何疾病持续时间的AA RA受试者，他们目前正在入组接受单次横断面检查。具体目标包括：1）评估RA患者整个生命过程中的社会地位与疾病严重程度之间的相关性，2）确定RA患者整个生命过程中的社会背景和社会地位与疾病严重程度之间是否存在独立相关性，3）测试RA患者整个生命过程中的社会地位（整个生命过程）和社会地位与疾病严重程度之间关系的假设中介。 公共卫生相关性： 非裔美国人在类风湿性关节炎（RA）的研究中明显代表性不足，因此在这个种族/族裔群体中有许多关于该疾病的重要问题尚未回答。该项目旨在阐明社会决定因素与非裔美国人RA健康结局的作用，并且是第一个专门研究非裔美国人RA人群社会经济地位问题的项目。更好地了解这些问题将为设计临床干预措施和制定政策以缩小这些差距提供宝贵的基础。

DESCRIPTION (provided by applicant): Rheumatoid arthritis (RA) is a multisystem autoimmune disease associated with considerable morbidity and mortality worldwide. African Americans (AAs) have been markedly underrepresented in research on RA. The strong association between lower levels of individual socioeconomic status (SES) with poorer health outcomes in RA is well-established in whites, but less so in AAs. Recent data suggest that community social determinants, e.g., the socioeconomic environment of an individual's neighborhood and environmental exposures, may be operant in this regard, as well. In addition, racial segregation sorts individuals of comparable SES into vastly different neighborhood environments. AAs are often segregated from the white population, which may result in community influences differing for AAs and whites. The long-term goal of this proposal is to examine the relationship of social determinants across the lifecourse with health outcomes in AAs with RA. This project will be the first study to examine individual and community-level social determinants in an AA population with RA, by examining social position (childhood, current and lifecourse individual-level SES) and social context (community-level SES, environmental exposures, access to services and racial residential segregation). It will also be the first to examine perceptions (control, discrimination and neighborhood) that may act as mediators of outcomes in RA. The proposed project will be conducted using extensive demographic, socioeconomic, environmental, clinical and radiographic data collected through the Consortium for the Longitudinal Evaluation of African Americans with Early RA (CLEAR) registry and network, which consists of a Coordinating Center at the University of Alabama (UAB) and clinical sites at UAB and 4 other universities across the southeast. CLEAR has two components: CLEAR I with 350 AA participants with < 2 years of disease duration who are already enrolled and will be followed to year 5 of their disease; and CLEAR II with an anticipated 600 AA RA participants of any disease duration who are currently being enrolled for a single cross-sectional examination. Specific aims include: 1) To evaluate associations between social position across the lifecourse with disease severity in AAs with RA, 2) to determine whether there are independent associations between social context and social position across the lifecourse with disease severity in AAs with RA, and 3) to test hypothesized mediators in the relationships between social position (across the lifecourse) and social position with disease severity in AAs with RA. PUBLIC HEALTH RELEVANCE: African Americans have been markedly underrepresented in research on rheumatoid arthritis (RA), so there are many important unanswered questions regarding the disease in this racial/ethnic group. This project aims to clarify the role social determinants with health outcomes in African Americans with RA, and is the first to examine socioeconomic status issues specifically in an African American population with RA. A better understanding of these issues will provide an invaluable foundation for designing clinical interventions and creating policies to reduce these gaps.