Assessing Biological Pathways: Linking Neighborhoods to Cardiovascular Mortality

描述(由申请人提供)：越来越多的研究报告称，在社区环境如何影响个人健康行为、健康状况和/或死亡率方面，存在性别差异。尽管在这一领域的研究已经取得了长足的进步，但研究人员仍处于早期阶段，以确定社区特征实际上是通过哪些生物学途径“深入皮肤”，而医学研究所(IOM)呼吁进行基于性别的分析还没有得到落实。更具体地说，迄今为止的研究缺乏关于个人层面的社会人口、健康行为和生物标记物的数据、客观的社区数据以及关于个人死亡率的后续数据的必要组合。此外，在美国，缺乏系统地评估邻里因素与心血管疾病(CVD)死亡率之间的性别差异的工作。我们建议通过在全国成人样本中评估居住环境的关键方面与心血管疾病死亡率之间的生物学途径来解决文献中的这一差距。这项研究的具体目的是：1.评估所选择的社区环境特征(即社区社会经济状况、人口密度和居住稳定性)与后天心血管疾病生物风险因素之间的关系，并检查这些关系是否因性别而异，控制关键的个人健康行为和社会人口特征。2.评估心血管疾病的获得性生物危险因素与随后的心血管疾病死亡率之间的关系，并检查它们是否因性别不同而不同，并控制关键的个人健康行为和社会人口特征。3.评估获得性心血管疾病的生物风险因素在选定的社区环境特征和心血管疾病死亡率之间的中介作用，并研究它们的作用如何因性别而异，控制关键的个人健康行为和社会人口特征。拟议的项目将利用来自五个主要来源的综合数据：(1)第三次全国健康和营养检查调查(NHANES III)，(2)NHANES 1999-2004年；(3)美国人口普查；(4)兰德人口健康和健康差距中心(CPHHD)数据核心；和(5)国家死亡指数。通过NHANES数据可以获得生物标记物，包括传统的和最近确定的心血管疾病风险和死亡率的预测因素。总而言之，这些数据提供了一个独特的机会，可以评估社区环境与男性和女性心血管疾病风险和随后的死亡率之间的关键路径。 公共卫生相关性：拟议的研究侧重于在建筑、住房和土地使用政策领域可以解决的社区的社会和自然环境方面的干预。这项工作将阐明相关的公共政策努力和公共卫生干预措施，特别是心血管健康领域的公共政策努力和公共卫生干预措施，从长远来看如何能够改善健康行为、心血管风险因素和存活率，并缩小健康差距。拟议的基于性别的分析还有助于为改善男女人口健康的努力提供信息，而不会无意中增加健康差距。

DESCRIPTION (provided by applicant): A growing number of studies report gender differences in how the neighborhood environment impacts individual health behaviors, health status, and/or mortality. Although research in this domain has made great strides, researchers are still in the early stages of identifying the biological pathways through which neighborhood characteristics actually "get under the skin," and the Institute of Medicine's (IOM) call for gender- based analyses has not been fulfilled. More specifically, research to date has lacked the necessary combination of data on individual-level sociodemographic, health behavior and biological markers, objective neighborhood data, and follow-up data on individual mortality. Also, there is a dearth of work systematically assessing gender differences in the association of neighborhood factors and cardiovascular disease (CVD) mortality in the United States. We propose to address this gap in the literature by assessing biological pathways between key aspects of the residential environment and CVD mortality in a national sample of adults. The specific aims of this proposed research are to: 1. Assess the relationship between selected characteristics of the neighborhood environment (i.e., neighborhood socioeconomic status (NSES), population density, and residential stability) and acquired biological risk factors for CVD and examine whether these relationships differ by gender, controlling for key individual-level health behavior and sociodemographic characteristics. 2. Assess the relationship between acquired biological risk factors for CVD and subsequent CVD mortality, and examine whether they differ by gender, controlling for key individual-level health behavior and sociodemographic characteristics. 3. Assess the role of acquired biological risk factors for CVD as mediating pathways between the selected characteristics of the neighborhood environment and CVD mortality, and examine how their role may differ by gender, controlling for key individual-level health behavior and sociodemographic characteristics. The proposed project will draw on integrated data from five major sources: (1) Third National Health and Nutrition Examination Survey (NHANES III), (2) the NHANES 1999-2004; (3) United States Census; (4) RAND Center for Population Health and Health Disparities (CPHHD) Data Core; and (5) National Death Index (NDI). Biomarkers are available through the NHANES data, including both traditional and more recently identified predictors of CVD risk and mortality. Taken together, these data provide a unique opportunity to assess key pathways between neighborhood context and men's and women's CVD risk and subsequent mortality. PUBLIC HEALTH RELEVANCE: The proposed research focuses on aspects of the social and physical environment of neighborhoods interventions in the area of building, housing, and land-use policy could address. This work will shed light on how related public policy efforts and public health interventions, particularly in the area of cardiovascular health, could-in the long term-improve health behaviors, cardiovascular risk factors, and survival, as well as reduce health disparities. The proposed gender-based analysis can also help inform efforts to improve population health for both men and women without inadvertently increasing health disparities.