Impact of Social Determinants of Health in Diabetic Retinopathy

项目摘要 这是NIH K23职业发展奖的申请表。拟议项目的目标是 为候选人提供成为使用数据的独立临床科学家所需的高级技能 科学技术来检查糖尿病视网膜病变中健康的社会决定因素的作用。为了促进该 长期目标，候选人提出一个全面的培训计划，包括：1）正式课程， 获得应用健康科学信息学硕士学位，2）监督实践实践培训 她的多学科指导团队跨越医学，公共卫生和数据科学领域， 3)参加研讨会和讲习班。具体目标是：1）理解社会概念 健康的决定因素和公共卫生干预措施的原则，2）发展数据科学研究的技能 包括信息学和生物统计学，以及3）提交NIH R01和其他非NIH赠款， 这个项目的发现。 该研究项目将有助于实现职业发展目标。护理失误是一个主要的 糖尿病视网膜病变（DR）患者视力丧失的可预防原因， 社会经济地位最低的人。健康的社会决定因素（SDoH）在以下方面发挥着关键作用： 健康结果和这些健康差距的基础。当前系统解决DR中SDoH的尝试 由于缺少两个组成部分而受到限制：对高危人群的准确预测和识别 最具影响力的SDoH。本研究提案的重点是解决这一差距。在目标1）中，我们将使用 一种创新的方法，将社区一级的SDoH措施，从美国获得。 人口普查局在街区组水平上进行了测量，以预测护理失误。假设患者 来自社会经济地位较低、住房和食品更不安全的社区， 医疗保健获取和负担能力方面的困难更有可能在DR护理中遇到失误。在目标2）中，我们 将构建一个新颖的综合SDoH框架，将社会经济地位与DR护理失误联系起来 通过各种中介SDoH，包括住房稳定性，食品安全和医疗保健（访问， 价格和质量）。我们将使用中介分析来识别中介SDoH， 调解社会经济地位对DR护理失误的影响。假设是， 医疗保健是一个关键的调解人。这项研究的结果将用于开发后续的NIH R01 一项研究提案侧重于设计有针对性的干预措施，以消除护理失误并促进健康 在DR的公平。

PROJECT SUMMARY This is an application for the NIH K23 Career Development Award. The goal of the proposed project is to provide the candidate with advanced skills needed to become an independent clinician-scientist using data science techniques to examine the role of social determinants of health in diabetic retinopathy. To facilitate this long-term goal, the candidate proposes a comprehensive training plan including: 1) formal coursework and obtaining a Master of Science in Applied Health Sciences Informatics, 2) practical hands-on training overseen by her multidisciplinary mentoring team who span the fields of medicine, public health, and data science, and 3) involvement in seminars and workshops. Specific goals are to: 1) understand concepts in social determinants of health and principles of public health interventions, 2) develop skills in data science research including informatics and biostatistics, and 3) submit an NIH R01 and other non-NIH grants that build on the findings of this project. The research project will facilitate attainment of the career development goals. Lapses in care is a major preventable cause of vision loss among patients with diabetic retinopathy (DR) and disproportionately affects individuals of the lowest socioeconomic status. Social determinants of health (SDoH) play a critical role in health outcomes and underlie these health disparities. Current attempts to systematically address SDoH in DR have been limited by two missing components: accurate prediction of the at-risk population, and identification of the most impactful SDoH. The focus of this research proposal is to address this gap. In Aim 1) we will use an innovative approach of incorporating neighborhood-level SDoH measures, as obtained from the U.S. Census Bureau measured on the block group level, to predict lapses in care. The hypothesis is that patients from neighborhoods characterized by lower socioeconomic status, more housing and food insecurity, and difficulty with healthcare access and affordability are more likely to experience lapses in DR care. In Aim 2) we will construct a novel comprehensive SDoH framework that links socioeconomic status to lapses in DR care through various intermediary SDoH including housing stability, food security, and healthcare (access, affordability, and quality). We will use mediation analysis to identify the intermediary SDoH that most strongly mediates the impact of socioeconomic status on lapses in DR care. The hypothesis is that access to healthcare is a critical mediator. Results from this research will be used to develop a subsequent NIH R01 research proposal focused on designing targeted interventions to eliminate lapses in care and promote health equity in DR.