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

项目总结/摘要 这个指导以患者为导向的研究职业发展奖（K23）将支持大卫李博士的 培训和研究，以使用针对地理区域和基于社区的方法来确定各种因素 与糖尿病结局的微观差异相关，并加强对糖尿病患者血糖控制的监测。 黑人虽然糖尿病的患病率在全国范围内不断增加，但目前的糖尿病监测方法 无法在社区水平上确定糖尿病预后不良的热点。然而，基于A 一种新的糖尿病监测地理方法发现，糖尿病负担的增加 集中在特定的社区，特别是黑人社区。对于黑人成年人来说， 控制与较少的初级保健访问，较低频率的HbA 1c测试和较高的发病率相关。 急诊室使用和住院，尤其是糖尿病黑人男性。鉴于这种罕见的 与通常的医疗保健来源的互动，基于社区的设置可以提供预先 现有的信任和参与，以优化居住在社区的高风险人群的健康结果 糖尿病并发症的高发区因此，本提案的具体目标是：1）使用地理空间 和定量方法来确定哪些微观背景因素导致糖尿病患者的局部差异， 黑人社区的结果，2）使用地理定位的定性访谈，以确定 解释某些黑人社区糖尿病预后不良的邻里水平因素，以及3）执行 社区为基础的HbA 1c测试和糖尿病自我护理调查的黑人男子生活在社区， 糖尿病并发症的高发率。这项以社区为基础的研究将利用现有的伙伴关系， 在纽约市当地黑人拥有的理发店网络中。理发店越来越多地 促进黑人男性健康和衡量黑人男性健康结果的有效场所，黑人男性是一个拥有 糖尿病的高死亡率和发病率。这项研究的结果将为未来的R系列提供信息 应用程序，以扩大这种方法，以其他高风险亚组在黑人社区和其他种族， 糖尿病预后极差的少数民族社区。李博士的培训目标与他的 研究目标，并将进一步提高他的理解：1）先进的定量分析，2）定性 和混合方法，3）社会和行为科学，和4）糖尿病教育和管理。的 拟议的研究和培训将在纽约大学医学院进行， 纽约大学其他专业学校的资源，提供了出色的合作机会， 学习和多学科研究。这种环境，除了他的研究和培训计划将 为李博士提供一个坚实的基础，使他能够加速他的职业生涯，实现成为 一个完全独立的临床研究者，致力于减少糖尿病负担的差异， 糖尿病并发症的社区的健康结果。

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.