Projects and Grants per year
Grants and Contracts Details
Description
Abstract
In 2000, social determinants of health (SDOH), including education, racial segregation, social support, poverty
and income inequality, were linked to over 800,000 deaths in the United States. Moreover, prior studies have
shown that SDOH explain more of the current disparity in cardiovascular mortality than traditional
atherosclerotic cardiovascular disease (ASCVD) risk factors. However, current ASCVD risk prediction tools,
like the 2013 pooled cohort equations (PCE), comprised of separate equations for white and Black men and
women, do not incorporate SDOH. This project will analyze ASCVD risk attributable to SDOH and structural
racism, defined as the macrolevel systems, social forces, institutions, ideologies, and processes that interact to
generate and reinforce inequities among racial and ethnic groups. Clinical practice guidelines recommend
using the PCE for ASCVD risk estimation. However, these equations are inadequate because: (1) individuals
of Hispanic ethnicity were not included in the derivation cohort, so the results are not directly applicable to
Hispanic individuals; and (2) self-identified race is a social construct and a proxy for the lived experience of
structural racism. Incorporating SDOH into ASCVD risk prediction models could eliminate the need for race-
specific risk equations while capturing the effect of racism on ASCVD risk. The goal of this study is to establish
ASCVD risk estimators reflecting the impact of SDOH. We will create sex-specific equations with race and
ethnicity as covariates (rather than as stratification variables), robustly adjusting for traditional ASCVD risk
factors as well as SDOH. These alterations have the potential to increase statistical power while eliminating
race-stratified risk estimation. In this project, we will leverage several existing NHLBI-funded cohort studies to
build an ethnically and socioeconomically diverse sample by incorporating data from the Generation 3 and
Omni 2 cohorts of the Framingham Heart Study, Jackson Heart Study, Multi-Ethnic Study of Atherosclerosis,
Hispanic Community Health Study, and Coronary Artery Risk Development in Young Adults Study. Our
overarching hypothesis is that, upon robust adjustment for SDOH, the effects of race and ethnicity on ASCVD
risk will be attenuated, obviating the need for considering race in ASCVD risk assessment. To investigate this
hypothesis, we will: identify SDOH variables that reflect the impact of structural racism using structural
equation modeling (Aim 1); develop sex-specific ASCVD risk estimating equations, adjusting for race, ethnicity,
traditional ASCVD risk factors, and SDOH using Cox proportional hazards regression (Aim 2); and internally
validate ASCVD risk prediction models (Aim 3). Successful completion of this project would pave the way for
integrating a risk estimator into electronic health records for broad use in clinical settings, allowing for earlier
and more robust prevention measures – potentially preventing millions of ASCVD events and resulting in
reduced healthcare expenditure.
Status | Finished |
---|---|
Effective start/end date | 10/1/21 → 6/30/22 |
Funding
- National Center for Advancing Translational Sciences
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Projects
- 1 Finished
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Kentucky Center for Clinical and Translational Science - Institutional Career Development Core
Kelly, T. (PI), Arnett, D. (CoI), Curry, T. (CoI), DiPaola, R. (CoI), Duncan, M. (CoI), Evers, B. M. (CoI), Giannone, P. (CoI), Guy, R. K. (CoI), Heath, E. (CoI), Jicha, G. (CoI), Kern, P. (CoI), King, V. (CoI), Lacy Leigh, M. (CoI), Lephart, S. (CoI), McLouth, L. (CoI), Roberts, J. (CoI), Samaan, M. (CoI), Supinski, G. (CoI), Talbert, J. (CoI) & Williams, L. (CoI)
National Center for Advancing Translational Sciences
8/15/16 → 6/30/22
Project: Research project