Social Determinants of Outcomes in African Americans with Rheumatoid Arthritis

描述（由申请人提供）：类风湿关节炎（RA）是一种多系统自身免疫性疾病，在世界范围内具有相当高的发病率和死亡率。非裔美国人（AAs）在类风湿关节炎研究中的代表性明显不足。较低的个人社会经济地位（SES）水平与RA较差的健康结果之间的强烈关联在白人中得到证实，但在黑人中则不那么明显。最近的数据表明，社区社会决定因素，例如个人所在社区的社会经济环境和环境暴露，也可能在这方面起作用。此外，种族隔离将社会经济地位相当的个体划分到截然不同的社区环境中。黑人往往与白人隔离，这可能导致黑人和白人对社区的影响不同。本建议的长期目标是检查整个生命过程中社会决定因素与RA患者健康结果的关系。该项目将是第一个通过检查社会地位（童年、现在和一生中个人层面的社会地位）和社会背景（社区层面的社会地位、环境暴露、服务获取和种族居住隔离）来检查AA人群中RA患者的个人和社区层面的社会决定因素的研究。它也将是第一个检查可能作为类风湿关节炎结果中介的感知（控制、歧视和邻里关系）。拟议的项目将使用广泛的人口统计、社会经济、环境、临床和放射学数据进行，这些数据是通过非洲裔美国人早期类风湿性关节炎纵向评估联盟（CLEAR）注册和网络收集的，该联盟由阿拉巴马大学（UAB）的协调中心和UAB以及东南部其他4所大学的临床站点组成。CLEAR有两个组成部分：CLEAR I有350名AA参与者，他们已经入组，病程< 2年，将被随访到疾病的第5年；和CLEAR II，预计有600名任何疾病持续时间的AA RA参与者，他们目前正在接受单次横断面检查。具体目的包括：1)评估AAs合并RA患者全生命周期社会地位与疾病严重程度之间的关系；2)确定AAs合并RA患者全生命周期社会背景和社会地位与疾病严重程度之间是否存在独立的关联；3)检验AAs合并RA患者全生命周期社会地位和社会地位与疾病严重程度之间关系的假设中介。

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.