Race, Socioeconomic Status, Diet and Chronic Kidney Disease

描述（由申请人提供）：慢性肾脏疾病（CKD）的种族差异在社会经济地位低（SES）的人群中最为严重，饮食因素（健康食品的有限供应和不健康的饮食模式）可能是这种差异的主要原因。低社会经济地位的非洲裔美国人（AA）更有可能经历粮食不安全（无法负担营养充足和安全的食物），生活在“食物沙漠”（低收入居民无法获得健康食品和快餐店占主导地位的地区），这可能导致饮食模式的种族差异。关于饮食干预在CKD发病率或进展高风险的低SES AA中的潜在有效性知之甚少。迫切需要开展研究，量化低SES AA中不良饮食与CKD发病率和进展差异之间的相关性，并确定改善该人群饮食习惯的有效策略，这可能会减少CKD中的种族性皮炎。该提案的总体目标是：1）在一项基于全国人群的研究中，确定饮食模式的种族差异对低SES个体进展至终末期肾病（ESRD）的种族差异的贡献; 2）检查健康食品的可用性对患者有效性的影响，通过使用既定的措施和开发一种新的AA家庭内健康食品可用性措施，对高血压不受控制的低SES AA进行家庭和社区层面的干预; 3）使用定性方法确定健康饮食模式的感知障碍，并确定在CKD极高风险的低SES AA中被认为是可接受的潜在干预策略;以及4）通过采用社区-社区参与式研究。这个K23指导职业发展奖的候选人Deidra Crews博士是约翰霍普金斯大学肾脏病学系的医学助理教授，也是韦尔奇预防，流行病学和临床研究中心的副教授。她的长期目标是通过她作为临床研究者的工作来改善弱势群体的健康状况。这项申请的首要目标是建立她成功和独立的职业学习机制，以缩小CKD的种族差异。在杰出导师和顾问的指导下，Crews博士将通过营养，临床试验和社区参与式研究的进一步教学培训，以及通过新的补充研究的表现，扩展她在临床流行病学和健康差异研究方面的先前培训和工作。她将在韦尔奇中心、约翰霍普金斯彭博公共卫生学院和消除心血管健康差异霍普金斯中心的丰富培训环境中开展这项工作。Crews博士提出的工作不仅将确保她成功过渡到R 01资助的独立研究者，而且还将大大有助于了解CKD中的种族和社会经济差异。

DESCRIPTION (provided by applicant): Racial disparities in chronic kidney disease (CKD) are most profound among persons of low socioeconomic status (SES), and dietary factors (limited availability of healthy foods and unhealthy dietary patterns) likely underlie much of this disparit. Low SES African Americans (AAs) are more likely to experience food insecurity (the inability to afford nutritionally adequate and safe foods) and live in "food deserts" (areas where low-income residents do not have access to healthy food and fast food restaurants predominate) which likely contributes to racial differences in dietary patterns. Little is known regarding the potentil effectiveness of dietary interventions among low SES AAs at high risk for CKD incidence or progression. Studies quantifying the association between poor diet and disparities in CKD incidence and progression among low SES AAs and identifying effective strategies to improve dietary habits in this population are critically needed, and could lead to reduced racial disparitis in CKD. The overall objectives of this proposal are to 1) determine the contribution of racial differences in dietary patterns to racial disparities in progression to end stage renal disease (ESRD) among low SES individuals in a national population-based study; 2) examine the impact of availability of healthy foods on the effectiveness of a patient, family and community level intervention among low SES AAs with uncontrolled hypertension by using established measures and developing a novel measure of healthy food availability within AAs' homes; 3) identify perceived barriers to healthy dietary patterns and identify potential interventional strategies deemed acceptable among low SES AAs at very high risk for CKD using qualitative methodology; and 4) develop and pilot-test a tailored dietary intervention for low SES AAs at very high risk for CKD by employing the principles of community-based participatory research. The candidate for this K23 Mentored Career Development Award, Dr. Deidra Crews, is an Assistant Professor of Medicine in the Division of Nephrology at Johns Hopkins University and an Associate Faculty Member at the Welch Center for Prevention, Epidemiology and Clinical Research. Her long term goal is to improve health outcomes among vulnerable populations through her work as a clinical investigator. The overarching goal of this application is to establish her successful and independent career studying mechanisms to narrow racial disparities in CKD. Under the guidance of exceptional mentors and advisors, Dr. Crews will extend her prior training and work in clinical epidemiology and health disparities research through further didactic training in nutrition, clinical trials and community-based participatory research, and through the performance of novel, complementary studies. She will conduct this work in the rich training environment of the Welch Center, the Johns Hopkins Bloomberg School of Public Health, and the Hopkins Center to Eliminate Cardiovascular Health Disparities. Dr. Crews' proposed work will not only assure her successful transition to an R01-funded independent investigator, but will also contribute substantially to what is known about racial and socioeconomic disparities in CKD.