Prioritizing county-level social determinants that contribute to the greater burden of diabetes and hypertension in the US

项目摘要/摘要 在美国，心血管疾病(CVD)的死亡人数在经历了几十年的下降后开始增加。 尽管心血管疾病死亡人数增加的原因尚不清楚，但预防、检测和 对心血管疾病危险因素(即糖尿病和高血压)的最佳治疗将是预防任何 心血管疾病死亡率进一步上升。目前，美国14%的成年人患有糖尿病，其中三分之一是 未确诊，29%的成年人患有高血压。然而，在心血管疾病风险因素中存在着明显的差异。 负担，特别是健康的社会决定因素。这些决定因素是 糖尿病和高血压的发展。然而，它们在临床实践中基本上被省略了， 决策。人们越来越意识到社会决定因素对健康结果的影响， 但目前还不清楚应该评估哪些因素，也不清楚如何将这些信息整合到当前的 练习一下。健康的社会决定因素是广泛的，因此重要的是描述那些可能 对预防、治疗和控制糖尿病和高血压的影响最大，可能是 用于通知目标计划和政策的发展。我们建议对社区进行调查 以及导致糖尿病和高血压负担更大的个人社会决定因素 美国东南部通过利用国家数据库、医疗保险索赔管理数据库和 一项前瞻性队列研究的基础设施，NIH资助的地理和种族差异的原因 中风研究，在2003-07年间招募了30,239名中老年人。我们将在此基础上 这些资源用于解决以下目标：1)确定县级社会决定因素的关联性 分别与县级糖尿病和高血压的患病率和发病率进行比较 美国东南部；2)评估县级健康的社会决定因素与县级的联系 东南部老年人中糖尿病和高血压的患病率和发病率 美国使用医疗保险数据库；以及3)评估县级和个人级社会团体的联合 个人水平糖尿病和高血压患病率和发病率的健康决定因素， 在美国东南部的与会者中。这项提案将优先考虑这些社会决定因素 在美国东南部，与糖尿病和高血压负担更大相关的健康问题 帮助指导预防计划和干预措施，以减少这种过度风险。

PROJECT SUMMARY/ABSTRACT Deaths from cardiovascular disease (CVD) have begun to increase in the US after decades of decline. Although the reasons underlying this increase in CVD deaths are unclear, the prevention, detection, and optimal treatment of CVD risk factors (i.e., diabetes and hypertension) will be essential for preventing any further increases in CVD mortality. Currently, 14% of adults in the US have diabetes, of which 1 in 3 is undiagnosed, and 29% of adults have hypertension. However, stark disparities exist in the CVD risk factor burden, particularly by social determinants of health. These determinants are key contributors to the development of diabetes and hypertension. Yet, they have largely been omitted from clinical practice and decision-making. There is increasing awareness of the influence of social determinants on health outcomes, but it is not clear exactly which factors should be assessed or how to integrate this information into current practice. Social determinants of health are extensive, so it is important to characterize those that are likely to have the greatest influence on the prevention, treatment and control of diabetes and hypertension and may be used to inform the development of targeted programs and policies. We propose to investigate the community and individual social determinants that contribute to a greater burden of diabetes and hypertension in the southeastern US by leveraging national databases, the Medicare claims administrative database and the infrastructure of a prospective cohort study, the NIH-funded Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, that enrolled 30,239 middle-aged and older adults in 2003-07. We will build upon these resources to address the following aims: 1) determine the association of county-level social determinants of health with the county-level prevalence and incidence of diabetes and hypertension, separately, in the southeastern US; 2) evaluate the association of county-level social determinants of health with the county-level prevalence and incidence of diabetes and hypertension, separately, among older adults in the southeastern US using the Medicare database; and 3) evaluate the association of county-level and individual-level social determinants of health with individual-level prevalent and incident diabetes and hypertension, separately, among REGARDS participants in the southeastern US. This proposal will prioritize those social determinants of health that are associated with a greater burden of diabetes and hypertension in the southeastern US and help guide prevention programs and interventions to reduce this excess risk.