Using agent-based modeling to compare strategies that can reduce rural-urban disparities in cardiovascular disease

项目摘要 在美国，可归因于心血管疾病(CVD)的城乡死亡率差距越来越大 在过去的几十年里，许多国家都在采取行动。预防性保健提供和提供的复杂相互作用 社区层面的行为和背景因素导致心血管健康的差异 农村居民和城市居民之间的差距。最近，系统科学和仿真建模发挥了重要作用 在评估、选择和实施循证干预措施方面发挥重要作用。然而， 现有的模型既没有考虑到农村人口的具体特征，也没有考虑到农村人口的具体特征 社区，或这些社区的卫生保健服务和其他背景因素。我们建议 使用基于代理的建模--一种系统科学的方法，它结合了来自不同来源和 模拟真实世界的临床或社区环境--以帮助理清这些复杂性，阐明 并确定农村社区中潜在有效的干预措施。 我们的长期目标是找到有效的临床和公共卫生解决方案，以缩小城乡差距 佐治亚州和纽约州农村社区的心血管健康。采取综合预防措施 从医疗保健和社区的角度来看，我们将使用基于代理的模型来实现我们的特定目标 以社区为基础预防心血管疾病，并测试以下干预措施在农村地区的有效性 县一级。首先，我们将评估改善卫生保健提供和获得的健康影响 基于家庭的远程监测计划和扩大保险覆盖范围，重点关注三大心血管疾病风险 因素：高血压、糖尿病和高胆固醇(目标1)。第二，我们将评估对健康的影响 公共卫生干预措施，包括改善食品环境、社区健康促进、 增加烟草税，以减少与心血管疾病相关的四个重要生活方式因素：肥胖， 不健康的饮食、缺乏运动和吸烟(目标2)。在目标3中，我们将使用CVD政策模型，一个很好的- 验证的美国基于人口的心血管疾病流行病学模拟模型和转换预测的益处 目标1和目标2中测试的七个风险因素和生活方式对心血管疾病下游影响的影响 事件。这将使我们能够评估这些单独或联合干预城乡的潜力。 国家一级的心血管疾病发病率和死亡率以及直接医疗费用的差异。建议数 研究是创新的，因为我们开发了一个政策模拟模型来为健康决策提供信息 农村县心血管疾病的护理和公共卫生管理，将临床与社区系统相结合，以 找到最有效的循证干预方法。

Project Summary Rural-urban disparities in mortality attributable to cardiovascular disease (CVD) have widened in the United States during the past several decades. The complex interplay of preventive health care delivery and community-level behavioral and contextual factors contribute to the differences in cardiovascular health between rural and urban residents. Recently, systems science and simulation modeling have played an important role in the evaluation, selection, and implementation of evidence-based interventions. However, existing models do not account for either the specific characteristics of populations living in rural communities, or the health care services and other contextual factors of these communities. We propose to use agent-based modeling -- a systems science approach that incorporates data from various sources and simulates real-world clinical or community settings -- to help disentangle these complexities, elucidate causal pathways, and identify potentially effective interventions in rural communities. Our long-term goal is to find effective clinical and public health solutions to reduce rural-urban disparities in cardiovascular health among rural communities in Georgia and New York. Taking an integrated preventive health care and community perspective, we will accomplish our specific aims using an agent-based model of community-based CVD prevention and test the effectiveness of the following interventions at the rural county level. First, we will estimate the health impact of improving health care delivery and access using home-based telemonitoring programs and expanding insurance coverage, focusing on three major CVD risk factors: hypertension, diabetes and high cholesterol (Aim 1). Second, we will estimate the health impact of public health interventions, including improving the food environment, community-based health promotion, and increasing tobacco taxes for reducing four important lifestyle factors related with CVD: obesity, unhealthy diet, physical inactivity, and smoking (Aim 2). In Aim 3, we will use the CVD Policy Model, a well- validated US population-based CVD epidemiology simulation model and translate projected beneficial effects on the seven risk factors and lifestyles tested in Aim 1 and 2 into downstream impact on CVD events. This will allow us to assess the potential of these individual or combined interventions on rural-urban disparities in the incidence and mortality of CVD and direct medical costs at the state level. The proposed research is innovative because we develop a policy simulation model to inform decision-making for health care and public health management of CVD in rural counties, integrating clinical with community systems to find the most effective evidence-based intervention.