PESBART: Effects of Physical Environment and Stress in Blacks in Relation to Asth

描述（由申请人提供）：黑人在哮喘发病率和死亡率方面承担着不成比例的负担。在2005年关于医疗保健方面的种族差异的报告中，AHRQ确定，黑人与白人在医疗保健质量方面的第二大差异是哮喘病住院。BELT研究（黑人与LABA vs. Tiotropium的恶化；1R01HS019408- 01）是由AHRQ资助的，目的是比较长效β受体激动剂(LABA)/吸入皮质类固醇（ICS）与Tiotropium/ICS在延迟黑人哮喘患者恶化时间方面的有效性。这项研究在美国18个地点招募了1000名受试者，并对他们进行了至少6个月至18个月的随访，同时收集了可靠的哮喘结局数据。为了扩展BELT研究队列数据集的有用性和可持续性，提出了PESBART研究。该提案的目标是收集地理环境和压力数据，并在18个月的时间内利用利益相关者参与过程来开发新的比较有效性研究问题，并加强与BELT队列相关的当前数据基础设施。该项目的具体目标是：1)通过收集可能与哮喘结果相关的环境和压力暴露的地理信息，增加BELT数据基础设施的效用；2)对大多数BELT受试者的基因型数据进行预处理，为后续的遗传分析做准备；3)通过让在环境流行病学、人口遗传学、临床实践和患者倡导等领域具有专业知识的利益攸关方团队参与进来，加强BELT数据基础设施的可持续性和相关性；4)进行一项试点研究，评估地理数据元素的完整性和准确性及其回答PESBART利益相关者提出的研究问题的能力。了解环境暴露、压力和遗传决定因素对哮喘严重程度的相互作用，对个人决定居住地、政策制定者决定住房开发地点和其他城市规划问题、以及对利用个性化治疗范例感兴趣的医生都很重要。

DESCRIPTION (provided by applicant): Blacks bear a disproportionate burden of asthma morbidity and mortality. In its 2005 report on ethnic disparities in health care, AHRQ identified hospital admissions for asthma as the second largest disparity in quality of health care for Blacks versus Whites. The BELT study (Blacks and Exacerbations on LABA vs. Tiotropium; 1R01HS019408- 01) was funded through AHRQ to compare the effectiveness of long-acting beta agonists (LABA)/inhaled corticosteroids (ICS) vs. Tiotropium/ICS in delaying the time to exacerbation in Black patients with asthma. This study enrolled >1000 subjects at 18 sites across the United States and followed them for at least 6 months and up to 18 months, while collecting robust asthma outcome data. To extend the usefulness and sustainability of the BELT study cohort dataset, the PESBART study is proposed. The objective of this proposal is to collect geographic environmental and stress data and to utilize a stakeholder engagement process over an 18-month period to develop new comparative effectiveness research questions and to enhance the current data infrastructure as relevant to the BELT cohort. The specific aims of this project are to: 1) increase the utility of the BELT data infrastructure by collecting geographic information on the environmental and stress exposures that may be associated with asthma outcomes; 2) preprocess the genotype data generated on a majority of BELT subjects in preparation for subsequent genetic analyses; 3) enhance sustainability and relevance of the BELT data infrastructure by involving a team of stakeholders with expertise in areas of environmental epidemiology, population genetics, clinical practice and patient advocacy; and 4) perform a Pilot study that will assess the completeness and accuracy of the geographic data elements and its ability to answer the research questions proposed by the PESBART Stakeholders. Understanding the interaction of environmental exposure, stress, and genetic determinants in contributing to asthma severity are important to individuals making decisions about where to live, policy makers in making decisions about locations for housing developments and other urban planning issues, and physicians interested in utilizing personalized treatment paradigms.