Mixed-Methods Study of Multidimensional Adversity in Inner-City African American Adults with Chronic Kidney Disease and Type 2 Diabetes Mellitus

项目总结 大约40%的2型糖尿病患者(T2 DM)也有慢性肾脏疾病(CKD) 被称为糖尿病肾病(DKD)。DKD是终末期肾病(ESRD)的主要原因，以及 终末期肾病是糖尿病最昂贵的并发症。非裔美国成年人患癌症的可能性几乎是前者的两倍 患有DKD，进展为终末期肾病的可能性是其他患者的三倍。市中心的人口，由 主要是非洲裔美国人，患有DKD的风险很高。居住在市中心的挑战包括 多维逆境，定义为有三种或三种以上的社会逆境，如失业， 住房不稳定、粮食不安全、交通需求、公用事业需求、人际安全和经济压力。 居住在市中心的非裔美国成年人经历了多维的逆境，这与 影响DKD复杂的自我管理，如自我监控和行为修正。这个 非裔美国人、居住在市中心、患有2型糖尿病和多面性糖尿病的复合风险 逆境可能导致非裔美国成年人CKD进展速度加快， 扩大现有的健康差距。患者教育和自我管理行为改善患者 结果，并代表着DKD管理的基石。此外，中国的行为干预研究 患有T2 DM的非裔美国成年人将文化定制、同伴支持/辅导和社区融为一体 卫生工作者在改善短期临床结果方面表现出了希望。然而，他们的好处并不是 长期持续，它们不会对生活方式和行为的改变产生长期影响。此外， 现有的大多数研究没有考虑到市中心非裔美国成年人面临的独特挑战 这限制了非裔美国成年人的患者教育和自我管理行为的有效性 长期居住在市中心。同样，对患有T2 DM和CKD的非裔美国人成年人的研究表明 在多维逆境中生活的挑战很少，尽管有越来越多的证据表明 认识到多维逆境对这一人群的临床结果的负面影响。 因此，这项提议的目标是使用收敛的并行混合来解决这些知识差距 方法研究设计以了解多维逆境在非裔美国人中的作用和影响 患有DKD的成人。此外，该提案将确定适当的干预组成部分，这些组成部分将向 为应对多维逆境而制定的文化干预措施的发展 居住在美国的非裔美国人DKD患者的临床结果、生活质量和自我照顾行为 市中心。最终，这项提案的结果将作为解决以下问题的初步数据 一项大规模、适当动力、多中心、随机对照试验中的多维逆境 重点关注患有DKD的非裔美国成年人。

PROJECT SUMMARY Approximately 40% of individuals with type 2 diabetes (T2DM) have chronic kidney disease (CKD), also known as diabetic kidney disease (DKD). DKD is the leading cause of end stage renal disease (ESRD), and ESRD is the most expensive complication of diabetes. African American adults are almost twice as likely to have DKD and are three times more likely to progress to ESRD. Inner-city populations, made up of predominantly African Americans, are at high risk for DKD. Challenges of living in the inner-city include multidimensional adversity, defined as having three or more social adversities such as loss of employment, housing instability, food insecurity, transportation needs, utility needs, interpersonal safety, and financial strain. African American adults living in the inner-city disproportionately experience multidimensional adversity, which impacts the complex self-management of DKD such as self-monitoring and behavior modification. The compounded risks of being African American, living in the inner-city, having T2DM and multidimensional adversity likely contribute to the accelerated rate of CKD progression among African American adults and potentiate existing health disparities. Patient education and self-management behaviors improve patient outcomes and represent the cornerstone of DKD management. In addition, behavioral intervention studies in African American adults with T2DM incorporating cultural tailoring, peer-support/coaching, and community health workers have shown promise in improving short-term clinical outcomes. However, their benefits are not sustained long-term, and they do not produce long-term effects on lifestyle and behavior changes. Further, majority of existing studies do not account for the unique challenges of inner-city African American adults which limits effectiveness of patient education and self-management behaviors in African American adults living in the inner-city long-term. Similarly, studies in African American adults with T2DM and CKD that incorporate the challenges of living with multidimensional adversity are scarce, despite growing evidence which recognizes the negative effects of multidimensional adversity on clinical outcomes in this population. Therefore, the goal of this proposal is to address these gaps in knowledge using a convergent parallel mixed methods study design to understand the role and effect of multidimensional adversity in African American adults with DKD. In addition, this proposal will identify appropriate intervention components which will inform the development of a culturally tailored intervention that addresses multidimensional adversity to improve clinical outcomes, quality of life, and self-care behaviors in African American adults with DKD living in the inner-city. Ultimately, findings from this proposal will serve as a preliminary data for addressing multidimensional adversity in a large-scale appropriately powered, multicenter, randomized controlled trial focused on African American adults with DKD.