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ARRA Investments in Health Disparities—Chronic Disease

Public Health Burden
Many chronic diseases and conditions, including obesity, diabetes, and kidney disease, disproportionately affect racial and ethnic minority groups as well as people with lower socio-economic status (SES) in the United States.

Contributing Factors
ARRA funded grants are exploring factors contributing to health disparities in chronic disease prevalence and outcomes in the U.S.
  • Because diabetes management is so burdensome, non-adherence to a medical treatment plan is a common problem leading to poor outcomes in diabetes.  An ARRA project will evaluate rates and reasons for non-utilization of referred health services for diabetes in a large, diverse population, so that strategies may be developed to improve this aspect of treatment adherence.1
  • Childhood obesity is increasing in prevalence.  An ARRA project will examine the intersection of stress, eating behavior, and obesity in low-income pre-school aged children who are at increased risk of becoming overweight, which could provide data to help inform the development of more effective intervention and prevention programs.2
  • Another project will use data from national surveys and other sources to understand the individual-, family-, and community-level causes of ethnic/SES disparities in obesity and its co-morbidities, including type 2 diabetes and hypertension, as well as related health care issues.3
  • Patients with kidney failure are treated with dialysis, but more information is needed to tailor the choice of dialysis type to individual patient needs and improved clinical and economic outcomes.  An ARRA project will study survival data in dialysis patient databases to try and identify subgroups of dialysis patients with superior survival with different dialysis modalities.4
  • More information is needed on the progression of chronic kidney disease in Hispanic Americans.  ARRA funds will enhance retention and follow-up on the large number of hospitalizations that Hispanic participants in the Chronic Renal Insufficiency Cohort (CRIC) clinical study are experiencing, as hospitalizations represent an important outcome measure in the study.5
  • ARRA funds will provide a principal investigator with a foundation to launch an independent research career devoted to understanding health disparities in chronic kidney disease progression, and in reducing disparities in chronic kidney disease.6
  • The landmark Diabetes Prevention Program (DPP) demonstrated that lifestyle changes that lead to modest weight loss or use of the diabetes drug metformin reduce the onset of type 2 diabetes.  The Diabetes Prevention Program Outcomes Study (DPPOS) continues to follow participants of the DPP to examine the impact of diabetes prevention on long-term complications affecting the eye, kidney, nerves, and heart.  ARRA funds will support the Data Coordinating Center for the DPPOS.7

  1. 1RC1DK086178-01 -- Failure To Utilize Diabetes Health Services Following A Referral -- Karter, Andrew John (CA)
  2. 1RC1DK086376-01 -- Cortisol And Eating Behavior in Low-Income Preschool-Aged Children -- Lumeng, Julie C (MI)
  3. 1R01DK081335-01A1 -- Understanding Disparities in Obesity and Its Comorbidities in the US-- Wang, Youfa (MD)
  4. 1R21DK077341-01A2 -- Understanding Sources Of Bias And Outcomes In Peritoneal Dialysis Patient Research -- Kalantar-Zadeh, Kamyar (CA)
  5. 3R01DK072231-05S2 -- Hispanic Chronic Renal Insufficiency Cohort (CRIC) Study -- Lash, James P (IL)
  6. 3K23DK070757-04S1 -- Clinical and Behavioral Determinants in Chronic Kidney Disease Disparities -- Boulware, Leigh E (MD)
  7. 3U01DK048489-16S2 -- Diabetes Prevention Program Outcomes Study -- Fowler, Sarah E (MD)

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