Are Diabetes Risk and Preventive Behaviors Shared in Households?

描述(申请人提供)：糖尿病是一种复杂的、多因素的疾病，在美国有2600万人受到影响，另有7900万人处于糖尿病的高危状态。然而，90%的糖尿病高危人群不知道自己的风险，很少有人得到医疗保健提供者的指导，指导他们改善饮食、锻炼身体和减轻体重，以降低患糖尿病的风险。我们也很少知道这些行为选择在多大程度上受到一个人的社会关系的影响，特别是生活在同一个家庭、共享资源、拥有相同价值观和获得类似信息的伴侣或配偶。例如，癌症或糖尿病等疾病的出现会加剧家庭成员对疾病的担忧，并刺激他们采取预防行为。我们的目标是通过分析从2005年到2014年的大量、多样化的参保人群的纵向数据，来调查这些社会“溢出”对家庭内预防行为和糖尿病风险的影响。Kaiser Permanente North California拥有一个包含330万成员的纵向多种族数据库，提供了将生物识别、实验室和医疗服务利用联系起来的丰富机会 主要计划成员及其链接的从属成员的数据。我们将研究家庭中新的糖尿病诊断是否会促使伴侣或配偶改变他们的生活方式行为；这种预防行为的采用在人口统计学或社会经济群体中是否有所不同；以及这些行为是否在诊断后3-6年内保持不变。我们还将研究参加相同医疗保险计划的成年家庭成员，以及与这一时期新诊断为糖尿病的人住在一起的家庭成员本身是否有很高的患糖尿病风险。最后，采取的生活方式行为改变是否与家庭成员患糖尿病风险的降低有关？这项研究的发现可能会带来识别糖尿病高危人群的新方法--例如，医生通知患有新糖尿病的人，鼓励他们的家庭成员也进行检查。此外，这也可能导致新的研究，以帮助整个家庭改变并共同保持他们的生活方式行为。我们的建议旨在使用一套独特的、未得到充分利用的数据库来回答这些热门和创新的问题。利用我们埃默里大学和KPNC研究团队的综合和跨学科专业知识，我们将使用先进的统计和准实验方法来分析数据，控制可测量的偏差，并使用敏感性分析来探索无法解释的因素。这项研究在概念上是新颖的，在设计上是有效的，研究结果将对筛查建议、建议新诊断的糖尿病患者以及探索通过家庭刺激可持续健康行为的途径具有重要意义。

DESCRIPTION (provided by applicant): Diabetes is a complex, multi-factorial condition, affecting 26 million people in the United States and an additional 79 million people are at high-risk of developing diabetes. However, 90% of people at high-risk of diabetes don't know about their risk and very few are given guidance by their health care providers about improving their diets, physical activity, and lowering weight to reduce their risk of getting diabetes. We also know very little about how much these behavior choices are influenced by one's social connections, particularly partners or spouses that live in the same household, share resources, and have the same values and access to similar information. For example, emergence of diseases like cancers or diabetes can heighten family members' concerns of also developing disease, and stimulate them to engage in preventive behaviors. We aim to investigate these social "spillover" effects on preventive behaviors and diabetes risk within households by analyzing longitudinal data from 2005 to 2014 from a large, diverse insured population. Kaiser Permanente Northern California has a longitudinal and multi-ethnic database of 3.3 million members and offers a rich opportunity to link biometric, laboratory, and health service utilization data for primary plan members and their linked dependents. We will study whether a new diabetes diagnosis in the household prompts partners or spouses to change their lifestyle behaviors; whether this adoption of preventive behaviors is different across demographic or socioeconomic groups; and whether these behaviors are maintained 3-6 years after the diagnosis. We will also study whether adult family members that are on the same health insurance plan and live in the same household of someone that was newly diagnosed with diabetes in this time have a high risk of getting diabetes themselves. And lastly, whether the lifestyle behavior changes adopted are associated with reduced risk of diabetes in the family member? The findings from this study may lead to new ways of identifying people at high risk of diabetes - for example, doctors notifying people with new diabetes diagnoses to encourage their household members to get checked too. In addition, it may also lead to new studies to help whole families change and maintain their lifestyle behaviors together. Our proposal aims to use a unique and underutilized set of databases to answer these topical and innovative questions. Utilizing the combined and interdisciplinary expertise of our Emory University and KPNC study team, we will use advanced statistical and quasi-experimental methods to analyze the data, controlling for measurable biases and using sensitivity analyses to explore factors that cannot be accounted for. This study is novel in concept, efficient in design, and findings will have important implications for screening recommendations, for advising people with a new diagnosis of diabetes, and for exploring avenues to stimulate sustainable healthful behaviors through families.