Assessing Biological Pathways: Linking Neighborhoods to Cardiovascular Mortality

描述（由申请人提供）：越来越多的研究报告了社区环境如何影响个人健康行为、健康状况和/或死亡率的性别差异。尽管这一领域的研究已经取得了很大的进步，但研究人员仍处于识别邻里特征真正“深入皮肤”的生物学途径的早期阶段，医学研究所（IOM）对基于性别的分析的呼吁尚未得到满足。更具体地说，迄今为止的研究缺乏个人层面的社会人口学、健康行为和生物标志物、客观社区数据和个人死亡率的随访数据的必要组合。此外，在美国，缺乏系统地评估社区因素与心血管疾病（CVD）死亡率之间的性别差异的工作。我们建议通过在全国成人样本中评估居住环境关键方面与心血管疾病死亡率之间的生物学途径来解决文献中的这一空白。本研究的具体目的是：1。评估社区环境的选定特征（即社区社会经济地位（NSES）、人口密度和居住稳定性）与CVD获得性生物学风险因素之间的关系，并检查这些关系是否因性别而不同，控制关键的个人健康行为和社会人口特征。2. 评估CVD的获得性生物学危险因素与随后的CVD死亡率之间的关系，并检查它们是否因性别而不同，控制关键的个人健康行为和社会人口学特征。3. 评估CVD的获得性生物风险因素在社区环境选择特征和CVD死亡率之间的中介通路中的作用，并检查其作用如何因性别而异，控制关键的个人健康行为和社会人口学特征。拟议的项目将利用来自五个主要来源的综合数据：(1)第三次全国健康和营养检查调查（NHANES III）； (2) NHANES 1999-2004；(3)美国人口普查；(4)兰德人口健康与健康差异中心（CPHHD）数据核心；(5)国家死亡指数（NDI）。生物标志物可通过NHANES数据获得，包括传统的和最近确定的CVD风险和死亡率预测因子。综上所述，这些数据为评估社区环境与男性和女性心血管疾病风险及随后死亡率之间的关键途径提供了独特的机会。

DESCRIPTION (provided by applicant): A growing number of studies report gender differences in how the neighborhood environment impacts individual health behaviors, health status, and/or mortality. Although research in this domain has made great strides, researchers are still in the early stages of identifying the biological pathways through which neighborhood characteristics actually "get under the skin," and the Institute of Medicine's (IOM) call for gender- based analyses has not been fulfilled. More specifically, research to date has lacked the necessary combination of data on individual-level sociodemographic, health behavior and biological markers, objective neighborhood data, and follow-up data on individual mortality. Also, there is a dearth of work systematically assessing gender differences in the association of neighborhood factors and cardiovascular disease (CVD) mortality in the United States. We propose to address this gap in the literature by assessing biological pathways between key aspects of the residential environment and CVD mortality in a national sample of adults. The specific aims of this proposed research are to: 1. Assess the relationship between selected characteristics of the neighborhood environment (i.e., neighborhood socioeconomic status (NSES), population density, and residential stability) and acquired biological risk factors for CVD and examine whether these relationships differ by gender, controlling for key individual-level health behavior and sociodemographic characteristics. 2. Assess the relationship between acquired biological risk factors for CVD and subsequent CVD mortality, and examine whether they differ by gender, controlling for key individual-level health behavior and sociodemographic characteristics. 3. Assess the role of acquired biological risk factors for CVD as mediating pathways between the selected characteristics of the neighborhood environment and CVD mortality, and examine how their role may differ by gender, controlling for key individual-level health behavior and sociodemographic characteristics. The proposed project will draw on integrated data from five major sources: (1) Third National Health and Nutrition Examination Survey (NHANES III), (2) the NHANES 1999-2004; (3) United States Census; (4) RAND Center for Population Health and Health Disparities (CPHHD) Data Core; and (5) National Death Index (NDI). Biomarkers are available through the NHANES data, including both traditional and more recently identified predictors of CVD risk and mortality. Taken together, these data provide a unique opportunity to assess key pathways between neighborhood context and men's and women's CVD risk and subsequent mortality. PUBLIC HEALTH RELEVANCE: The proposed research focuses on aspects of the social and physical environment of neighborhoods interventions in the area of building, housing, and land-use policy could address. This work will shed light on how related public policy efforts and public health interventions, particularly in the area of cardiovascular health, could-in the long term-improve health behaviors, cardiovascular risk factors, and survival, as well as reduce health disparities. The proposed gender-based analysis can also help inform efforts to improve population health for both men and women without inadvertently increasing health disparities.