The
University of North Carolina
2005
Federal Priority
|
Program in Racial Disparities and
Cardiovascular Disease
Background
According
to statistics from the National Institutes of Health (NIH), cardiovascular
diseases are the most common cause of morbidity and mortality in the United States,
accounting for nearly half of all deaths and health care expenditures. Compared to the rest of the nation, the State
of North Carolina
ranks high with respect to the magnitude of this problem. In 2000, death rates for cardiovascular
disease for all North Carolinians exceeded the national average by 4%, but the
rates for minority populations were a staggering 50% higher than the national
average (226 vs. 154 per 100,000 populations) with much of the increase
attributed to counties in the eastern part of North Carolina. Despite the fact that this situation is not
new, physicians do not presently understand the basis of these disparities
among minorities. Fortunately, resources
are now available to address this problem systematically, including the Human
Genome Project and the large sets of genomic, genetic and population
information encompassed by that effort.
Against
this backdrop, a significant hurdle remains: the lack of sufficiently advanced
computer-based information technology to integrate enormous data sets containing
tens of thousands of genes and 3 billion units of information per patient, with
clinical and population information.
This challenge is amplified by the fact that these data sources are not
designed to integrate with one another.
Unfortunately, traditional funding mechanisms do not exist for the
development of the novel information system and operational infrastructure
needed for a multidisciplinary approach to this problem.
Program in Racial Disparities and Cardiovascular
Disease
The
State of North Carolina
and the University
of North Carolina are
uniquely positioned to understand and find solutions to the problem of racial
disparities in cardiovascular diseases based on demographic, clinical and scientific
resources, resulting in a greater understanding of how racial disparities
contribute to differences in wellness, health care needs and outcomes. North Carolina is home to a diverse people
including the Lumbee Tribe, the largest Native American population east of the
Mississippi, a significant African-American population (21.6% of the state
population versus 12.3% nationally) and the fastest growing Latino population
in the country, with 400% growth between 1990 and 2000. Of particular relevance to this issue is that
Eastern North Carolina African-American individuals living in some counties
have a significantly higher than average risk of cardiovascular disease while
in other counties the risk is average. Such disparities, even among minority
populations, offer insight into the general problem of racial health disparities
and its solution.
The
University of North Carolina at Chapel
Hill, through its nationally recognized Schools of Medicine and
Public Health, provides a unique, highly interactive team approach to finding
solutions to address racial disparities in cardiovascular disease. The Brody School of Medicine at East Carolina
University supports the
fastest growing clinical division of cardiology in the region and serves a
racially diverse population with a high prevalence of cardiovascular disease
and a death rate exceeding the state and national averages. This partnership
between UNC-Chapel Hill and East
Carolina University,
also known as the joint Program in Racial Disparities and Cardiovascular
Disease, will enable unprecedented access to diverse cardiovascular patient
populations and collaborations among world renowned cardio-thoracic surgeons
and cardiologists, as well as scientifically-based data outcomes that do not
currently exist.
The
Program in Racial Disparities and Cardiovascular Disease will assemble the
patient access and computational resources necessary to address the problem of
racial disparities in cardiovascular disease.
The primary areas of focus of this multidisciplinary effort will be the
development of hardware (a state-of-the-art computer database platform);
“middleware” (specific computer applications for database communications
between different data sets, in collaboration with the IBM
Life Sciences Research Division and computer scientists at the ECU School of
Computer Science and Technology); technology development (new tools and
“rules” that will allow for the integration and mining of genomic data to crack
the code of ethnic and racial disparities in cardiovascular diseases; and human
resources (physicians, basic scientists, computer scientists, programmers,
database managers and population scientists).
While the technology will
enable a greater understanding of disease prevalence and targeting, equally important
benefits will include improved overall health care and greater access to
cardiovascular health care for minorities, and opportunity for economic
development in rural,
disadvantaged areas. In Fiscal Year (FY) 2005, Congress appropriated $725,000
in Federal funds to help initiate the Program in Racial Disparities. The promise of those funds has already allowed
East Carolina University
to hire a renowned cardiovascular faculty member for additional work in this
field. FY2005 funding and
subsequent awards will target congestive heart failure in eastern North Carolina;
establish a state-wide congestive heart failure registry and a heart failure
education program for primary care doctors.
Further, the Program will employ novel information systems to transmit data
to the registry at ECU while providing samples for genetic and proteomic
analysis from a racially diverse group to project partners at UNC-Chapel
Hill. By establishing community-based
heart failure clinics, the joint Program can immediately address issues of
access, improve the care of patients near their homes, decrease
hospitalization, improve mortality, and decrease the cost of care, including a
resulting decreased dependence upon Medicaid/Medicare services. It is anticipated that such programs can be
generalized to the State and nation as a whole and can also be adapted for
other cardiovascular diseases such as stroke, diabetes, hypertension and
atherosclerosis.
Action
Requested: The North Carolina Congressional Delegation is requested
to support additional funding to assemble the computational resources and
provider and patient access to address the problem of racial disparities in
cardiovascular disease.
Labor, Health and Human
Services and Education FY 2006 Appropriations
Item: Program in Racial Disparities and Cardiovascular
Disease
Request: $2,275,000
Agency: Department of Health and Human Services: Centers for Disease Control
Account: Public
Health Improvement and Leadership