Health Disparities Research and Minority Aging Researcher Training Review: National Institute on Aging 2012
Review Committee Members
Eliseo Perez-Stable – Chair
Ana Maria Cuervo
At the January 2012 meeting of the Task Force for Minority Aging Research (TFMAR), a subcommittee of the National Advisory Council on Aging, a request was made and subsequently approved by Council to review health disparities research and the training of minority researchers over the prior 10 years when the last comprehensive review of those programs was conducted. This document summarizes the results of that review and the recommendations from the TFMAR to the NIA Director.
The committee noted that, although there is overlap between research and training, they are not one and the same and are to be reviewed separately. Thus, the following questions were to be addressed:
- What is the current NIA portfolio related to health disparities research? What are the associated outcomes, gaps and what else should be done?
- What is the current NIA portfolio related to training of researchers of diverse backgrounds? What are the associated outcomes, gaps and what else should be done?
It was determined that a step-wise process would be used to address these questions.
- The NIA Office of Planning, Analysis, and Evaluation (OPAE) conducted an extensive portfolio analysis of health disparities research and minority aging researcher training over the 10-year period.
- The TFMAR met with the NIA director, all division directors, and IRP for oral reports on highlights of health disparities research and minority aging researcher training and for discussion of future directions.
- The Division of Behavioral and Social Research (BSR) conducted an independent review of their health disparities research using a panel of experts, including the chair of the TFMAR and former Council members, to develop a set of recommendations specific to BSR.
- The TFMAR reviewed and made overall recommendations, based on the information developed.
- Between 2001 and 2012 NIA funded a large and diverse portfolio of projects related to health disparities. 75% of the funded projects were research grants; 20% were training grants; and 5% were conference support grants.
- On average, 16% of grants supported by NIA (18% of R01s, 12% to 16% of grants supporting faculty or investigator development) were related to diversity or health disparities, and this proportion has remained fairly steady over the past 10 years.
- Among the relevant grants, 18% resulted from applications submitted in response to a request for applications (RFA) and 44% to program announcements (PAs); 38% were investigator initiated. 57% of the grants in DAB were devoted to training, whereas for the other three Divisions (DBSR, DN, and DGCG) research grants represented 80-90% of funded portfolio and 10-20% were training grants.
- DBSR has funded the largest number of grants (515 or 52%) and DAB the smallest number of grants (49 or 5%) related to health disparities.
- The committee used the NIH Health Disparities Strategic Plan (PDF, 1.3M) as a reference for the portfolio review. The plan focuses on four broad areas of emphasis: 1) research, 2) building research capacity,3) community outreach/information dissemination, and 4) integration of research, building capacity, and outreach. NIA has made the largest contribution to the research emphasis area of the NIH strategic plan (59% of projects). The largest expenditures have been in Alzheimer’s disease research (19%) and in research on the factors contributing to health disparities at older ages (16%).
- The Division of Geriatrics and Clinical Gerontology (DGCG) had more grants than other Divisions related to interventions to reduce health disparities, and the Council subcommittee suggested that more be done by NIA as a whole to develop and assess such interventions.
- Collaborations between NIA and other NIH institutes tend to be in training or conference sponsorship.
- All areas of diversity and health disparities research supported by NIA, particularly dementia and behavioral and social science research, have proven robust with respect to publications. More than 44,000 publications cited 911 NIA grants. Analysis of publications citing NIA grants showed that 40% of findings from these publications were related to factors influencing health and well-being and 23% of findings from the publications documented health-related differences in study populations.
- Between 2002 and 2011, NIA funded 34 Alzheimer's Disease Centers (ADCs). Between 2002 and 2006, ADCs recorded nearly 8,000 instances of diversity-related outcomes. Enrollment of non-white participants in the clinical studies conducted by ADCs has increased from 16% in 2006 to 20% in 2012.
- Training, dissertation, and career development grants are well distributed across NIA Divisions. After excluding diversity supplement (S) and institutional training (T) awards, 84% of grants to minority trainees were dissertation-related (F31, R36), including summer research experience (R25); the remainder were career (K07, K12) awards, small grants (R03), and meeting grants (R13). In contrast, 95% of trainees (45 out of 47) in health disparities research received a K award (K01, K08, K23, K25, and K99). The levels of success in terms of subsequent funding and publications were similar across grant mechanism.
- NIA-funded trainees (minority as well as HD trainees) had approximately 25% funding success rates and published 20 articles per trainee, on average in the 10 year time frame of the analysis.
- Between 2002 and 2011, NIA supported nearly 400 participants in the Summer Institute (SI). The search of NIA databases in this 10 year time frame, with a variable follow up period for the participants, yielded 655 publications for 400 SI participants, or 1.7 publications per participant, with a 24% funding success rates.
- Between 2002 and 2011, NIA supported nearly 500 participants in the Technical Assistance Workshop (TAW). These participants were awarded 154 grants in the 10 year time frame, resulting in a 30% funding success rate.
- Between 2002 and 2011, 229 individuals applied for Diversity Supplements (DS) and NIA awarded 76 DS, resulting in a funding success rate of 33% in the 10 year time frame.
- For the NIA Diversity Supplement Program, this mechanism has an average success rate of 50%. The success rate for grant applications excluding loan repayment among these early career investigators was 22% for funded research grant applications, although few appeared to have advanced to R01 awards.
- Summer institute, Technical Assistance Workshop and diversity supplements all had a significant beneficial effect on immediate and longer-term funding success of the participants and awardees.
- The Intramural program at NIA is funding the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study, an interdisciplinary, community-based, prospective longitudinal epidemiologic study that examines the influences of race and socioeconomic status (SES) on the development of age-related health disparities among socioeconomically diverse African Americans and whites in Baltimore. This study is unique because it is assessing over a 20-year period physical parameters as well as evaluating genetic, biologic, demographic, and psychosocial, parameters of African American and white participants in higher and lower SES strata.
Recommendations – from the Committee as a Whole
Health Disparities Research
Definition of Health Disparities
Despite improvements in the overall health of the American people, racial/ethnic minorities and other populations suffer disproportionately in the burden of illness and premature death. These populations are referred to as health disparity populations. More specifically, P.L. 106-525 defines a population as a health disparity population, “if, as determined by the Director of the Center [NCMHD/NIMHD] after consultation with the Director of the Agency for Healthcare Research and Quality, there is a significant disparity in the overall rate of disease incidence, prevalence, morbidity, mortality, or survival rates in the population as compared to the health status of the general population.” As such racial and ethnic minorities (i.e., African Americans, American Indians and Alaska Natives, Asians, Hispanics, and Native Hawaiians and Other Pacific Islanders), low socioeconomic status, and rural persons are currently designated as health disparity populations.
- Adopt an integrative conceptual model across NIA to approach health disparities research, which conveys that health disparities are multidimensional, and are caused by factors operating at various levels of analysis, including the biological, behavioral, sociocultural, and environmental. NIA should identify what areas are important to examine and how various dimensions or factors leading to health disparities interact. These interactions are important, because the biological factors underlying health disparities are not independent of socioeconomic factors, and health disparities will not be understood simply by focusing on one level of analysis.
- Reexamine the priority areas that guide the research in all of the divisions at NIA related to health disparities issues, now that NIH is in the process of developing a new strategic plan for health disparities research. Any reexamination of health disparities research across all divisions should give consideration to the aforementioned conceptual model.
- Understand the mechanisms that lead to disparities and develop strategies to reduce them. NIA should support more research on social and economic factors that predict health and well-being in vulnerable or diverse population groups, in recognition that the intersection between social conditions and health outcomes is critical. Strategies to reduce health disparities that address social and economic conditions (in addition to other factors) should be encouraged.
- Regularly examine data relevant to health disparities by race, ethnicity, and socioeconomic status to determine whether there is a narrowing in disparities.
- Take advantage of basic biology approaches, including animal and cellular models of inadequate response to stress. Encourage Aging Biology research in contributing to defining the molecular basis of health disparities and enhancing awareness of health disparities among basic biology investigators engaged in the study of age-related diseases.
- Support a robust intramural program that conducts aging specific health disparities research projects.
- Incentivize collaboration across funded NIA Centers to promote diversity.
- Sustain ADRC emphasis on work in minority populations and diverse investigators.
- Include the health disparities theme in large observational or intervention studies
- Consider cross-national studies as a mechanism for understanding health disparities issues in the U.S.
- There should be more attention to diversity outreach plans for all future NIA clinical trials and observational studies
Minority Aging Researcher Training
- Collect data on Summer Institute and Technical Assistance Workshop participants as allowed. For example, about 27% of Summer Institute participants go on to assistant professorships, but the outcomes for 39% of the total Summer Institute participants are unknown. Little is known about the race and ethnicity of participants. Establish tracking mechanisms for diversity supplement recipients.
- Expand RCMAR program links to other Centers, NIA Divisions, and promote as a model across NIH.
- Increase synergy between the RCMARs and the AD centers. The ADRC program includes a substantial portfolio of health disparities research and funds principal investigators of diverse backgrounds, and most of the RCMARs are located in the same institutions as ADRCs.
- Enhance Pepper and Nathan Shock Centers’ emphasis on health disparities research and diversity training.
- Provide and sustain leadership to further workforce diversity and health disparities research. Dr. J. Taylor Harden, who served as the point person for these areas, has retired. NIA is encouraged to identify someone who can devote constant attention to these issues, as did Dr. Harden.
- Sustain the current level of support for staff management of the diversity training portfolio. Health disparities training appears to be in good stead as the result of the oversight by a central individual whose sole function is to oversee diversity programs. NIA risks losing its leadership role in health disparities without that central individual in place. Expand staff support and responsibility to include oversight of health disparities research content to align with NIA priorities.
Further, the committee endorsed the recommendations from the BSR review committee. Finally, the committee recommended that future evaluations of health disparities research go into much greater depth regarding content. The opportunity to do so during this review was limited by the volume of material to be covered. This might be best accomplished as part of the quadrennial review of each division, as was done with BSR.