Using Geographically Targeted and Community-Based Methods to Identify Factors Associated with Micro-Level Disparities in Diabetic Outcomes and Enhance Monitoring of Glycemic Control Among Black Men

项目摘要/摘要 这项以患者为导向的导师研究职业发展奖(K23)将支持David Lee博士的 培训和研究，使用有地理目标和以社区为基础的方法来确定因素 与糖尿病预后的微观水平差异有关，并加强对血糖控制的监测 黑人。尽管糖尿病的患病率在全国范围内不断上升，但目前的糖尿病监测方法 无法在社区一级确定糖尿病预后不良的热点。然而，基于一项 新的糖尿病地理监测方法发现，糖尿病负担的增加已经 重点放在特定的社区，特别是黑人社区。对于黑人成年人来说，贫穷的糖尿病 控制与较少的初级保健就诊、较少的HbA1c检测和较高的 急诊科的使用和住院情况，尤其是糖尿病黑人男性。鉴于这种罕见的情况 与通常的医疗保健来源的互动，基于社区的设置可能会提供Pre- 现有的信任和参与，以优化居住在社区的高危人群的健康结果 这些都是糖尿病并发症的热点。因此，本提案的具体目标是1)使用地理空间 以及确定哪些微观背景因素导致糖尿病患者局部差异的量化方法 在黑人社区中的结果，2)使用针对地理目标的定性访谈来确定 社区层面的因素，解释了某些黑人社区糖尿病预后较差的原因，以及3)执行 以社区为基础的糖化血红蛋白检测和糖尿病自我护理调查 糖尿病并发症的高发病率。这项基于社区的研究将利用现有的合作伙伴关系 在纽约市当地黑人拥有的理发店网络内。理发店已经变得越来越多 在黑人男性中促进健康和衡量健康结果的有效网站，这一群体拥有 糖尿病的高死亡率和高发病率。这项研究的结果将为未来的R系列 将这一方法推广到黑人社区的其他高危亚群和其他种族和 糖尿病预后极差的种族社区。李博士的培训目标与他的非常相似 研究的目的和目标将进一步提高他对以下方面的理解：1)先进的定量分析，2)定性 和混合方法，3)社会和行为科学，4)糖尿病教育和管理。这个 拟议的研究和培训将在纽约大学医学院进行，并利用 纽约大学其他专业学校的资源，这些学校提供了绝佳的合作机会， 学习和多学科研究。这种环境，除了他的研究和培训计划外，还将 为李博士提供了一个坚实的基础，他可以从这个基础上加速他的职业生涯，朝着他成为 致力于减少糖尿病负担差异和改善糖尿病的完全独立的临床研究人员 被糖尿病并发症压垮的社区的健康结果。

Project Summary / Abstract This mentored patient-oriented research career development award (K23) will support Dr. David Lee’s training and research to use geographically targeted and community-based methods to identify factors associated with micro-level disparities in diabetic outcomes and enhance monitoring of glycemic control among Black men. Though the prevalence of diabetes is increasing nationally, current diabetes surveillance methods are unable to identify hot spots of poor diabetic outcomes at a community level. However, studies based on a novel geographic method of diabetes surveillance have found that the increase in diabetes burden has been focused in specific communities, especially among Black neighborhoods. For Black adults, poor diabetes control has been associated with fewer primary care visits, less frequent HbA1c testing, and higher rates of emergency department use and hospitalizations, especially among diabetic Black men. Given this infrequent interaction with a usual source of healthcare, community-based settings may provide the advantages of pre- existing trust and engagement to optimize health outcomes for high-risk populations living in neighborhoods that are hot spots of diabetic complications. Thus, the specific aims of this proposal are 1) to use geospatial and quantitative methods to identify which micro-contextual factors account for local disparities in diabetic outcomes among Black communities, 2) to use geographically-targeted qualitative interviews to identify neighborhood-level factors that explain poor diabetic outcomes in certain Black communities, and 3) to perform community-based HbA1c testing and diabetes self-care surveys among Black men living in neighborhoods with a high prevalence of diabetic complications. This community-based research will leverage existing partnerships within a network of local Black-owned barbershops in New York City. Barbershops have become increasingly effective sites for promoting health and measuring health outcomes among Black men, a population which has high rates of mortality and morbidity from diabetes. The results of this research will inform future R-series applications to expand this approach to other high-risk subgroups in Black neighborhoods and other racial and ethnic communities with extremely poor diabetic outcomes. Dr. Lee’s training goals closely parallel his research aims and will further enhance his understanding of: 1) advanced quantitative analysis, 2) qualitative and mixed methods, 3) social and behavioral science, and 4) diabetes education and management. The proposed research and training will be conducted at the New York University School of Medicine and leverage resources of the other professional schools at NYU, which offer outstanding opportunities for collaboration, learning, and multidisciplinary research. This environment, in addition to his research and training plan will provide Dr. Lee with a strong foundation from which he can accelerate his career towards his goal of becoming a fully independent clinical investigator dedicated to reducing disparities in diabetes burden and improving health outcomes in communities that are overwhelmed by diabetic complications.