Impact of multilevel risk and resilience factors on cardiovascular health in racially/ethnically diverse men and women

项目摘要/摘要 在美国，心血管疾病(CVD)仍然是主要的死亡原因。非裔美国人(AA)，低- 社会经济地位(SEP)群体、南方人和拉美裔人受到心血管疾病的影响不成比例。在……里面 此外，与女性相比，男性心血管疾病发病更早，可归因于以下原因的死亡率更高 心血管疾病。这些性别差异以及种族/民族和SEP差异是实现国民健康的挫折 股权和CVD削减目标。要减少心血管疾病的差异和差异，关键是要改善 心血管(CV)健康。AHA在2015年的一份声明中表示，这是改善 个人健康和减少心血管疾病在于解决健康的社会决定因素。这些决定因素包括 心理社会风险(如种族主义、歧视和低SEP)在多个层面上运作。新兴研究 表明个人、人际和社区层面的弹性资源可能会保护简历 面对多层次心理社会风险的健康通过间接影响，如更积极的健康行为 以及心理社会风险对生理功能的缓冲作用。复原力资源被定义为 在逆境中积极适应并表现出积极的行为/结果。与多个级别相比 心理社会风险、多层次复原力资源代表了新的、可能更具延展性的干预措施 目标。尽管越来越多的证据支持复原力资源对简历结果的保护作用， 关键的研究差距仍然存在。例如，大多数恢复力研究都没有与 差异人群，即无心血管疾病的人群，包括多水平的心理社会风险，或进行差异测试 性别和种族/民族群体之间的关系。因此，这项提议的目标是检查多级复原力 资源与简历结果相关，如果多层次的心理社会风险缓和了这些关系。 具体地说，关于种族/民族多样化的男性和女性在三个CV健康队列中登记的纵向数据 (即JHS、MESA、MASALA)将统一起来，以创建一个综合数据集。使用我们的集成数据 目的：(A)确定衡量多级风险和多级复原力的最可靠和最有效的措施是否 资源在性别和不同种族/族裔群体中表现出衡量不变性；(B)确定 随着时间的推移，多层次的复原力资源与理想的简历健康状况有关，如果多层次的心理社会 风险缓和观察到的关系；(C)确定多级复原力资源是否具有前瞻性 随着时间的推移与事件心血管事件相关，如果观察到中度的多水平心理社会风险 (D)量化旨在建立多层次的假设性干预措施的程度 复原力资源减少种族/民族和性别差异，在理想的个人简历健康和心血管事件方面，总体上和 多层次心理社会风险的水平。该项目响应全NIH、NHLBI、OBSSR和AHA 呼吁填补心理社会风险、韧性和简历结果研究方面的关键空白。

Project Summary/Abstract In the US, cardiovascular disease (CVD) remains the leading cause of death. African Americans (AAs), low- socioeconomic position (SEP) groups, southerners, and Hispanics are impacted disproportionately by CVD. In addition, compared to women, men have earlier onset of CVD and have had higher death rates attributable to CVD. These sex differences and racial/ethnic and SEP disparities are setbacks to achieving national health equity and CVD reduction goals. To reduce differences and disparities in CVD, it is critical to improve cardiovascular (CV) health. A 2015 AHA statement indicated that “the most significant opportunity” to improve CV health and reduce CVD lies in addressing the social determinants of health. Such determinants include psychosocial risks (e.g., racism, discrimination, and low SEP) operating at multiple levels. Emerging research indicates that resilience resources at the individual, interpersonal, and neighborhood levels may protect CV health in the face of multilevel psychosocial risks via indirect effects such as more positive health behaviors and buffering effects of psychosocial risks on physiological functioning. Resilience resources are defined as positive adaptation and display of positive behaviors/outcomes despite adversity. Compared to multilevel psychosocial risks, multilevel resilience resources represent novel and potentially more malleable intervention targets. Despite growing evidence supporting the protective effects of resilience resources on CV outcomes, critical research gaps remain. For example, the majority of resilience research has not been conducted with disparity populations, populations free of CVD, included multilevel psychosocial risks, or tested for differences between sex and racial/ethnic groups. Thus, the objective of this proposal is to examine if multilevel resilience resources are associated with CV outcomes and if multilevel psychosocial risks moderate these relationships. Specifically, longitudinal data on racially/ethnically diverse men and women enrolled in three CV health cohorts (i.e., JHS, MESA, MASALA) will be harmonized to create an integrated dataset. Using the integrated data we aim to: (a) determine whether the most reliable and valid measures of multilevel risk and multilevel resilience resources demonstrate measurement invariance across sex and diverse racial/ethnic groups; (b) determine if multilevel resilience resources are associated with ideal CV health over time and if multilevel psychosocial risks moderate observed relationships; (c) determine if multilevel resilience resources are prospectively associated with incident CVD events over time and if multilevel psychosocial risks moderate observed relationships; and (d) quantify the degree to which hypothetical interventions designed to build multilevel resilience resources reduce racial/ethnic and sex differences in ideal CV health and CVD events overall and by the level of multilevel psychosocial risks. This project responds to the NIH-wide, NHLBI, OBSSR, and AHA calls to fill critical gaps in psychosocial risk, resilience, and CV outcomes research.