Assessing the Impact of Educational Interventions on Reducing Disparities in Hypertension and Related Biomarkers

 描述(申请人提供)：高血压已被百万心脏倡议确定为美国心脏病发作和中风的主要可预防原因[1]。研究反复记录了少数族裔和社会经济地位较低的个人在高血压方面的差异[2]。认识到这一点，NHLBI呼吁进行研究，以解决高血压差异的社会和环境决定因素，作为其战略计划(目标3)的一部分。这项研究将通过关注教育干预在减少高血压差异方面的潜在作用，直接为这一目标做出贡献。在目标1中，我们 将使用国家健康和营养检查调查以及健康和退休研究的数据，对受教育程度对高血压和相关生物标志物的影响进行人口水平的估计。我们将利用一个独特的“准实验”，在这个实验中，州级学校质量衡量标准的差异导致个人教育成就的差异[3]。在目标2中，我们将使用相关的管理和索赔数据集，在大量不同的美国员工样本中检查教育程度对成年后高血压诊断的影响。目标1和目标2使用工具变量分析，这是一种处理教育和卫生之间未观察到的混淆的统计方法[4]。在目标3中，我们将使用目标1和目标2的结果--结合先前文献中的估计--作为计算机模型的输入。该模型将模拟不同的情景，以评估教育干预对心血管健康的回报。这一K08奖项的候选人是斯坦福大学的家庭医生和社会流行病学家丽塔·哈马德博士。在研究导致心血管疾病风险因素差异的社会因素方面，哈马德博士确立了自己作为早期独立研究者的地位。她的短期职业目标是获得先进的流行病学和统计学方法方面的专业知识，以研究教育对人群水平高血压的影响。这将有助于她的长期目标，即开发和评估社区一级的干预措施，以解决导致心血管疾病风险因素差异的社会因素。该奖项将支持Hamad博士追求以下职业发展计划，该计划是在她的指导团队的指导下设计的：(1)开发关于社会和经济干预在高血压流行病学中的作用的内容专门知识；(2)进行可应用于大型观察性数据集的高级统计准实验方法的博士水平培训；以及(3)制作计算机模型，以研究针对高血压差异的模拟干预的效果。这一职业发展奖将为哈马德博士准备的R01申请奠定基础，作为迈向独立研究职业生涯的下一步。她计划利用从这项研究中学到的科学经验来开发和评估社区层面的干预措施，该干预措施将通过增加高危亚群的教育来减少高血压的差异。

 DESCRIPTION (provided by applicant): Hypertension has been identified by the Million Hearts initiative as a leading preventable cause of heart attacks and strokes in the U.S. [1]. Studies have repeatedly documented the disparities in hypertension among racial minorities and individuals of lower socioeconomic status [2]. Recognizing this, the NHLBI has called for research to address the social and environmental determinants of hypertension disparities as part of its Strategic Plan (Goal 3). This study will directly contribute to this goal by focusing o the potential role of educational interventions to reduce disparities in hypertension. In Aim 1, we will produce population-level estimates of the effects of educational attainment on hypertension and related biomarkers using data from the National Health and Nutrition Examination Survey and the Health and Retirement Study. We will take advantage of a unique "quasi-experiment" in which differences in state-level school quality measures led to differences in individual educational attainment [3]. In Aim 2, we will examine the effect of educational attainment on hypertension diagnoses in adulthood among a large diverse sample of U.S. employees, using linked administrative and claims data sets. Aims 1 and 2 employ instrumental variables analysis, a statistical method that addresses unobserved confounding between education and health [4]. In Aim 3, we will use the results from Aims 1 and 2 - combined with estimates from prior literature - as inputs into a computer model. This model will simulate different scenarios to assess the returns of educational interventions to cardiovascular health. The candidate for this K08 award is Dr. Rita Hamad, a family physician and social epidemiologist at Stanford University. Dr. Hamad is establishing herself as an early independent investigator in the study of social factors that lead to disparities in risk factors for cardiovascular disease. Her short-term career goals are to gain expertise in advanced epidemiologic and statistical methods to study the effects of education on hypertension at the population level. This will contribute to her long-term goal, which is to develop and evaluate community-level interventions to address the social contributors to disparities in cardiovascular disease risk factors. This award will support Dr. Hamad's pursuit of the following career development plan, designed under the guidance of her mentoring team: (1) develop content expertise in the role of social and economic interventions in the epidemiology of hypertension; (2) undertake doctoral-level training in advanced statistical quasi-experimental methods that can be applied to large observational data sets; and (3) produce computer models to study the effects of simulated interventions that target disparities in hypertension. This career development award will lay the groundwork for an R01 application that Dr. Hamad will prepare as the next step towards an independent research career. She plans to use the scientific lessons learned from this research to develop and evaluate a community-level intervention that will reduce disparities in hypertension by increasing education among high-risk subgroups.