Barriers to Healthcare and Cardiovascular Risk Influences on Accelerated Brain Aging and Disability in Hispanic Persons with Multiple Sclerosis

项目摘要 这是第一个混合方法研究，以检查障碍，医疗共病[即， 心血管危险因素（CRF）]，并加速西班牙裔多发性硬化症患者的大脑衰老（H- MS）。该社区发展署将为克里斯蒂娜·罗曼博士提供必要的支持，她是一名训练有素的临床心理学家， 早期职业研究人员，以获得所需的指导和培训，以实现她的长期目标， 成为一名独立的临床研究人员和健康/健康的社会决定因素方面的领先专家 差异，脑老化，CRF和混合方法。H-CRMS的结果不成比例地比 他们的非西班牙裔同行。这些差异可能是由健康的社会决定因素造成的， 特别是与医疗保健获取相关的问题，因为早期干预和持续的持续维护 对MS预后至关重要。作为一个少数群体，西班牙裔人在获得公平待遇方面遇到更多障碍。 医疗保健，不仅有助于较差的MS结果，但也增加了他们的风险，共病医疗 条件，如CRF。CRF独立且不成比例地影响生活在美国的拉美裔和西班牙裔人 美国，大脑加速老化正在成为MS疾病进展的重要生物标志物， 对CRF也很敏感。本研究的主要目的是使用混合方法来调查 医疗保健和CRF障碍对MS相关结局的影响，即残疾程度和加速 大脑老化该项目符合NIMHD的使命，即“改善少数民族健康，减少健康 差距”我们将招募80名讲英语和/或西班牙语的H-BRMS参与虚拟或面对面的 学习课程。此外，样本的一个子集（N=40）将接受结构脑成像。研究旨在 如下：（1）调查CRF如何调节医疗保健获取障碍与 （2）将加速的脑老化与医疗保健障碍、加速的脑老化和残疾相关联; 以及（3）定性地检查获得医疗保健的生活经历。这项工作将直接影响到 早期干预，同时也填补了我们对社会因素如何直接 影响大脑健康和神经系统疾病的健康差异。为此，目前的CDA将利用 凯斯勒基金会丰富的基础设施和资源，并提供必要的培训：（1） 健康/健康差异的与保健相关的社会决定因素;（2）建模（即，机器学习） 年龄和心血管影响;（3）混合方法设计和分析;（4）专业 发展罗曼博士组建了一个模范的专家指导团队：约翰·德卢卡博士， Jennifer Manly博士，Adam Brickman博士，Denise Fyffe博士，具有SDOH/健康差异方面的专业知识， 心血管对脑老化的影响，以及混合方法的设计和分析。提供的培训 该CDA将确保罗曼博士成功过渡到独立调查员， 承担着NIMHD减少健康差距的使命。

Project Summary Abstract This is one of the first mixed methods studies to examine barriers to healthcare, medical comorbidities [i.e., cardiovascular risk factors (CRF)], and accelerated brain aging in Hispanic persons with multiple sclerosis (H- pwMS). This CDA will provide the necessary support for Dr. Cristina Román, a trained clinical psychologist and early career researcher, to obtain the mentorship and training needed to reach her long-term of goal of becoming an independent clinical researcher and leading expert in social determinants of health/health disparities, brain aging, CRFs, and mixed methods. H-pwMS have disproportionately worse outcomes than their non-Hispanic counterparts. These disparities are likely driven by social determinants of health (SDOH), especially those related to healthcare access, since early intervention and consistent, ongoing maintenance are critical to MS prognosis. As a minoritized group, Hispanics encounter more barriers to accessing equitable healthcare, not only contributing to poorer MS outcomes, but also increasing their risk for comorbid medical conditions, like CRF. CRFs independently and disproportionately impact pwMS and Hispanic persons living in the U.S., Accelerated brain aging is emerging as an important biomarker of disease progression in MS that is also sensitive to CRFs. The primary aim of the proposed study is to use mixed-methods to investigate the impact of barriers to healthcare and CRFs on MS-related outcomes, namely level of disability and accelerated brain aging. This project aligns with NIMHD’s mission to “improve minority health and reduce health disparities.” We will recruit eighty English and/or Spanish-speaking H-pwMS to partake in virtual or in-person study sessions. In addition, a subset of the sample (N=40) will undergo structural brain imaging. Study aims are as follows: (1) investigate how CRFs moderate the relationship between barriers to healthcare access and disability; (2) correlate accelerated brain aging to barriers to healthcare, accelerated brain aging, and disability; and (3) qualitatively examine lived experiences accessing healthcare. This work will have direct implications for early intervention, while also filling a substantial gap in our understanding of how societal factors directly impact brain health and health disparities in neurological disorders. To this end, the current CDA will capitalize on the on the rich infrastructure and resources of Kessler Foundation and provide necessary training in: (1) healthcare related social determinants of health/health disparities; (2) modeling (i.e., machine learning) of brain aging and cardiovascular influences; (3) mixed-methods design and analysis; and (4) professional development. Dr. Román has assembled an exemplary mentorship team of experts: John DeLuca, PhD, Jennifer Manly, PhD, Adam Brickman, PhD, Denise Fyffe, PhD with expertise in SDOH/health disparities, cardiovascular influences on brain aging, and mixed methods design and analysis. The training afforded by this CDA will ensure Dr. Román makes a successful transition to independent investigator who continues to carry NIMHD’s mission to reduce health disparities.