REasons for Geographic And Racial Differences in Stroke-Myocardial Infarction-4 (REGARDS-MI-4)

黑白冠心病与心力衰竭 尽管进行了数十年的研究和全国性的公共卫生运动，但美国的差距依然存在。 健康的社会决定因素(SDH)，如结构性种族主义在健康差距中的作用 仅在1%的出版作品中进行了研究。关于SDH的研究很少从生命过程的角度来看待 有患冠心病和心力衰竭的风险。在急性健康事件的压力下恢复的能力，或称弹性，是 这是一个以患者为中心的重要结果，但SDH对复原力的影响尚不清楚。过去的几年 研究检查了世界卫生组织(WHO)的结构性SDH和中间SDH SDH委员会(WHOCSD)纵向国家样本的概念框架 严格判定CHD和HF终点，这是本申请的目的之一。我们建议 一系列研究填补了这些空白，同时也提供了严格判定的CHD和HF事件 和死因给了许多有兴趣使用这些数据的调查人员(到目前为止，超过500人已经 使用这些数据)。我们在指导的基础上提出了一个正式的为期一年的职业生涯 早期调查人员发展方案(ESI)，特别是代表人数不足的少数群体 (URM)。本申请的具体目的是：(目标1)进行研究，检查潜在的 在世界卫生组织可持续发展委员会概念框架的指导下，分三个专题探讨健康差距的机制 范围：a)冠心病的发病率和复发率；b)心力衰竭的发病率和复发率 射血分数和射血分数降低的心衰；c)事件或 复发的冠心病或心力衰竭事件。(目标2)继续裁决冠心病事件、心力衰竭住院和 死因支持我们小组以外的调查人员的广泛研究，并将 与医疗保险数据进行队列，以支持进行医疗服务利用研究的调查人员。(目标3) 支持心血管疾病健康公平研究人员的发展，特别是通过一个新的 针对一批早期调查人员的指导性研究方案，包括分析和统计 支持和每年为期两天的卫生公平研究夏季学院的演示、培训、模拟 学习部分，和网络。早期调查人员毕业时将具备以下方面的特定能力 心血管疾病健康公平研究。拟议的拨款将为政策、宣传和设计 通过产生新的证据进行干预，SDH和卫生服务中的差异导致 发病和复发的冠心病和心力衰竭的人群水平差异，以及在 冠心病或心力衰竭事件。我们的多学科团队包括流行病学家、社会学家、卫生服务部门 研究人员、生物统计学家、临床医生和参与者咨询委员会，确保严谨和相关性 这项拟议的研究。继续为Goods-MI基础设施提供资金将支持一系列 由不断扩大的调查小组领导的其他研究。资助还将扩大致力于发现实现所有美国成年人健康公平的策略的研究人员队伍，这是一个目标 在NHLBI、国家科学院、疾病预防控制中心、美国心脏协会的支持下， 以及美国所有主要的专业协会。

Black-White coronary heart disease (CHD) and heart failure (HF) disparities persist in the US despite decades of research and national public health campaigns. The role of social determinants of health (SDH) like structural racism in health disparities has been studied in only 1% of published work. Few studies of SDH have taken a life course perspective related to risk of CHD and HF. The ability to recover after the stress of an acute health event, or resilience, is an important patient-centered outcome, but the influence of SDH on resilience is unknown. Few past studies have examined both structural and intermediary SDH in the World Health Organization's (WHO) Commission on SDH (WHOCSD) conceptual framework in a longitudinal national sample with rigorously adjudicated CHD and HF endpoints, which is one of the aims of this application. We propose a series of studies to fill these gaps, while also providing rigorously adjudicated CHD and HF events and causes of death to a host of investigators interested in using these data (to date, over 500 have used these data). We build on a track record of mentoring to propose a formal year-long career development program for early-stage investigators (ESI), especially underrepresented minorities (URM). The specific aims of this application are to: (Aim 1) conduct studies examining underlying mechanisms of health disparities, guided by the WHOCSD conceptual framework, in three thematic areas: a) the incidence and recurrence of CHD; b) the incidence and recurrence of HF with preserved ejection fraction and HF with reduced ejection fraction; c) reserve and resilience after an incident or recurrent CHD or HF event. (Aim 2) To continue to adjudicate CHD events, HF hospitalizations, and causes of death to support a wide range of studies by investigators beyond our group, and to link the cohort with Medicare data to support investigators conducting health services utilization studies. (Aim 3) To support the development of researchers in CVD health equity, especially URMs, through a new mentored research program for a cohort of early stage investigators, including analytic and statistical support and an annual 2-day Health Equity Research Summer Institute of presentations, training, mock study section, and networking. Early stage investigators will graduate with specific competencies in CVD health equity research. The proposed grant will inform policy, advocacy, and the design of interventions by generating new evidence on which SDH and disparities in health services lead to population-level disparities in incident and recurrent CHD and HF, and on resilience in recovery after a CHD or HF event. Our multidisciplinary team includes epidemiologists, sociologists, health services researchers, biostatisticians, clinicians, and a participant Advisory Board, assuring rigor and relevance of the proposed research. Continued funding for the REGARDS-MI infrastructure will support a host of additional studies led by an expanding group of investigators. Funding will also expand the cadre of researchers dedicated to discovering strategies to achieve health equity for all US adults, a goal supported by NHLBI, the National Academy of Sciences, the CDC, the American Heart Association, and all major professional societies in the US.