Sci. Aging Knowl. Environ., 13 February 2002
Vol. 2002, Issue 6, p. vp1
[DOI: 10.1126/sageke.2002.6.vp1]

VIEWPOINT

NIA Supports Minority Investigators and Research that Addresses Health Disparities Between Minority and Non-Minority Elderly Populations

Francis L. Bellino

The author is in the Biology of Aging Program at the National Institute on Aging, Gateway Building, Suite 2C231, Bethesda, MD 20892-9205, USA. E-mail: bellinof{at}nia.nih.gov

http://sageke.sciencemag.org/cgi/content/full/sageke;2002/6/vp1

Key Words: funding • minority • health • National Institute on Aging • grants

Introduction

The existence of disparities in the health status of people who are members of minority races, and the lack of understanding about the underlying mechanisms behind known health disparities, were largely ignored by researchers for most of the 20th century. However, as we entered the 21st century, the National Institutes of Health (NIH) embarked on an ambitious project to improve the health of the entire population of the United States. This project focuses on the striking health disparities in the burden of illness and death experienced by African Americans, Hispanics, Native Americans, Alaska Natives, Asians, and Pacific Islanders, as compared with Caucasians. These disparities are evident through shorter life expectancies as well as higher rates of specific diseases and conditions that result in substantial morbidity and mortality, such as cardiovascular disease, diabetes, and prostate cancer. Life expectancy at birth is 76 years for Caucasians and only 69 years for African Americans and other minority races.

In this article, I first highlight some of the known health disparities in minority patients and follow with examples of current research that might provide clues regarding the biological mechanisms underlying these health disparities. I then discuss how the National Institute on Aging (NIA) is responding to the challenge to make the later years of life as healthy and productive as possible across all segments of the population. Finally, I describe grant programs designed to support minority investigators and biology of aging research that is applicable to health disparities in minorities.

Diseases That Affect Minority Races Disproportionately

Prostate cancer. African American men are two to three times more likely to die from prostate cancer than are Caucausian men, and Asian men show a lower prevalence of prostate cancer than do Caucasian men. The increased propensity for prostate cancer in African Americans has been shown not to be attributable to socioeconomic status (1, 2). Studies revealed that, relative to Caucasians, prostate cancer tissue from African Americans shows (i) a fourfold increase in c-Met protein expression for androgen-dependent cancers, and a sixfold increase in c-Met and hepatocyte growth factor (HGF) expression in androgen-independent cancers. Both c-Met and HGF are associated with prostate cancer progression (3); (ii) a greater extent of apoptosis and down-regulation of the anti-apoptotic protein Bcl-2, which is potentially responsible for the loss of apoptotic control in prostate tumors (4); and (iii) earlier initiation and a higher prevalence of high-grade prostatic intraepithelial neoplasia, which is generally recognized as a likely precursor to carcinoma (5). African American men with no personal history of prostate cancer have lower serum levels of insulin-like growth factor-2 (IGF-2) and IGF-binding protein-3 (IGFBP-3) than do prostate cancer-free Caucasians who have at least one first-degree relative (father or brother) with prostate cancer (6). IGF-2 and IGFBP-3 are components of the IGF system known to regulate proliferation and apoptosis in prostate cancer cells. Despite an expectation that higher serum androgen levels might account in part for the greater incidence of prostate cancer in minorities, most studies show no significant difference among African Americans, Caucasians, and Asians (7, 8).

Cardiovascular disease and obesity. A major health problem that commonly afflicts elderly people is cardiovascular disease, to which African Americans are more susceptible than are Caucasians. High blood pressure, which is related to cardiovascular disease, is also more common in African Americans than in Caucausians. Several studies suggest that biological factors underlie this racial difference: A genetic polymorphism in endothelial nitric oxide synthase, which is inversely associated with hypertension, is less common in African Americans than in Caucasians (9). In addition, African Americans show higher plasma levels of endothelin-1, a peptide with potent vasopressor actions, than do Caucasians (10).

Pima Indian males are known to require a greater dose of beta-adrenergic agonist to increase their heart rate than do Caucasian males, suggesting that the Pima Indians are less sensitive to beta-adrenergic effects on heart rate. Low sympathetic nervous system (SNS) activity, which is also observed in Pima Indians (11), is associated with obesity. The combined differences in beta-adrenergic agonist sensitivity and SNS activity may contribute to the lower prevalence of hypertension and increased prevalence of obesity in Pima Indian males (12).

Osteoporosis. Another common disease in aged people is osteoporosis, to which African Americans are less susceptible than are Caucasians. Increased growth hormone secretion in African Americans as compared to Caucasians might account for the fact that African Americans have higher bone mineral density; this in turn might explain the decreased risk of osteoporosis (13).

As these examples show, ethnic differences in diseases commonly associated with aging are clearly apparent. However, we're really only at the beginning of understanding the biological bases for these differences. These studies are difficult to conduct, because in the absence of appropriate animal models for racial and ethnic health disparities, they must rely on access to human tissue, with its associated genetic and environmental heterogeneities. In addition, important ethical limitations on human experimentation increase the complexity of such an experimental approach. In the next section, we describe ways in which the NIH and NIA are addressing the various issues of minority research.

NIH and NIA Respond to a Major Health Need



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Fig. 1. NIA seeks to make the later years of life as healthy and productive as possible across all segments of the population. [Credit: PhotoDisc]

 
The history. To address the apparent health disparities experienced by minority races, each of the institutes and centers of the NIH contributed to the development of a 5-year NIH Strategic Research Plan to Reduce and Ultimately Eliminate Health Disparities. The Strategic Plan came into being because of a strong push from the U.S. government and was a response to legislation that established the National Center for Minority Health and Health Disparities (NCMHD) at the NIH. John Ruffin, when sworn in as the first director of the NCMHD, defined its mission thus: "While the diversity of the American population is one of the Nation's greatest assets, one of its greatest challenges is reducing the profound disparity in health status of America's racial and ethnic minorities, Appalachian residents, and other similar groups, compared to the population as a whole. And although some of the causes of disparate health outcomes---such as differences in access to care---are beyond the scope of biomedical and bio-behavioral research, the NIH can play a vital role in addressing and easing health disparities involving cancer, diabetes, infant mortality, AIDS, cardiovascular illnesses, and many other diseases."

However, before the nudge from Congress, the National Advisory Council on Aging, which guides the direction of research at the NIA, convened a committee, headed by James Jackson of the University of Michigan, to evaluate in depth the research and research training programs of the NIA that focused on minority health disparities and minority investigators. Jackson expressed his belief that for years, research on minorities has been rife with racist undertones or worse, simply ignored. Jackson noted that these practices must change, because "if we understand the mechanism by which social class and socioeconomic status influences health, we can develop interventions that can make a difference."

The recommendations generated by this landmark self-assessment by the NIA were then used to guide the institute's research decisions, an approach that Jackson says is crucial for the improvement of minority research. "Historically, race, ethnicity, and, to some degree, gender were viewed as nuisance variables," he said. These factors interfered with and confounded scientists' understanding of universal principles, which were then extrapolated to the population at large. Instead of universalism, Jackson endorses a more culturally specific view that if scientists want to understand the ways in which people age, they also need to understand the racial and ethnic influences, particularly the social and psychological ones.

The NIA's Contributions to the Strategic Plan

The contribution of the NIA to the NIH Strategic Plan focuses on initiatives to advance research on aging, with the ultimate objectives of reducing and eliminating health disparities among all of the elderly, including racial and ethnic minorities. Each of the four NIA extramural programs--Biology of Aging, Geriatrics, Neuroscience and Neuropsychology of Aging, and Behavioral and Social Research--developed agendas within the boundaries of their own particular missions. For example, the NIA targeted specific diseases of the elderly that show racial or ethnic disparities in occurrence, progression, and treatment outcomes. These include Alzheimer's disease and associated caregiving, menopause, frailty, cancer, and hypertension and other cardiovascular diseases.

The Biology of Aging Program at the NIA has two major goals regarding biomedical research on health disparities: to increase the number of minority investigators who conduct research on the biology of aging, and to support the research of investigators who focus on biological mechanisms of aging that underlie the observed health disparities. What types of research might fit under the mantle of "racially and ethnically diverse" biology of aging research? We know of several diseases associated primarily with the elderly that differ substantially in incidence (the number of new cases within a defined period of time) and prevalence (the number of cases present in a population at one point in time), depending on racial or ethnic status. Some of these diseases are more prevalent in minority populations and others are less prevalent. Similarly, the propensity to develop certain diseases can be higher or lower in minority populations. It would be useful to understand which of these differences owe their genesis primarily to differing biological or genetic causes, rather than cultural, environmental, or dietary factors. In general, studies on the latter causes need to precede studies that focus on biological underpinnings. Once cultural, environmental, and dietary factors have been ruled out as the cause of the discrepancy, one can begin to develop a biological hypothesis. The investigator then needs to ask how biological processes involved in aging participate in the genesis and/or progression of a particular disease or condition. For example, are different racial/ethnic populations more or less susceptible to byproducts of, or protection from, oxidative or glycative processes that damage, and thus alter the function of, cellular components? Are macromolecular repair processes equally efficient in these various populations? Do programmed changes that occur with age, such as declines in hormone production (such as growth hormone, dehydroepiandrosterone, and serum androgen or estrogen levels) or immune function, differ substantially, either quantitatively or qualitatively, according to one's racial or ethnic category? Are there animal models that mimic racial or ethnic differences that researchers can use to explore the underlying biological mechanisms?

What does the NIA hope to accomplish in first decade of the 21st century? In the Strategic Plan, NIA Director Richard Hodes, states, "While these strategic plan goals appropriately highlight the critical importance of this endeavor, it is not clear to what extent its objectives can be achieved over the next decade, even with the most optimistic assumptions for improving health among minorities. What science will be able to do in the next decade is to address and answer questions about causes of health disparities among older adults. The immediate goal will be to identify research needs, such as the need to understand the racial gap in life expectancy, and promote appropriate research and training activities in response to these needs. A longer-term goal will be to apply the outcomes of research to measures that will reduce and ultimately eliminate racial disparities in health."

Special Grant Programs to Support Biology of Aging Research Applicable to Health Disparities

The NIA R03 pilot grant program specifically invites researchers to submit grant applications that deal with "research leading to the identification of underlying mechanisms, including cellular and molecular mechanisms, linked to racial/ethnic differences in late-life function or disease. . ." This specific language related to health disparities research has been included in the annual issuances of the R03 program announcement over the past several years and is included in the 2002 announcement. Annual updates of the R03 program announcement can be found in the NIH Guide for Grants and Contracts or on the NIA home page. This program announcement invites applications from minority or nonminority investigators who are either "new investigators" [that is, they are neither current nor former principal investigators on NIH research projects (R01), FIRST awards (R29), subprojects of program project (P01) or center (P50) grants or the equivalent] or "established investigators" proposing research unrelated to any federally funded research project in which the investigator participates. The purpose of this program is to provide support for pilot research that is likely to lead to a subsequent individual research project grant (R01) that is focused on a significant aspect of "aging" research. In the 2002 version of the pilot grant program announcement, this award provides $50,000 in direct costs for 1 year, but this is subject to change in future issuances of the program announcement. Further instructions related to this award are provided in the program announcement referred to above.

Special Grant Programs to Support Minority Investigators

There are a variety of NIH and NIA grant award programs to support research that is conducted by minority investigators and that focus on the underlying biological mechanisms of aging, whether or not the research is directly related to health disparities. These awards will be summarized here, either as general NIH programs applicable to all NIH institutes or centers, or as NIA-supported programs.

NIH-supported programs for minority investigators.

1. MARC/MBRS programs. The NIH offers several grant programs that focus specifically on those investigators who are members of racial or ethnic minority groups that are underrepresented in biomedical research (as determined by the applicant's institution). These programs include the generally well-known Minority Access to Research Careers (MARC) and Minority Biomedical Research Support (MBRS) programs administered by the National Institute of General Medical Sciences (NIGMS). Further information on these programs is available at the NIGMS Web site (http://www.nigms.nih.gov/about_nigms/more.html).

2. F31 predoctoral individual fellowship awards. The National Research Service Award Predoctoral Fellowship for Minority Students provides up to 5 years of support for research training leading to a Ph.D. or equivalent research degree; the combined M.D./Ph.D. degree; or other professional degrees combined with a research doctoral degree in the biomedical sciences, behavioral sciences, or health services research. These fellowships are designed to enhance the racial and ethnic diversity of the biomedical, behavioral, and health services research labor force in the United States. Further information is provided in the program announcement PA-00-069 located on the NIH Web page (http://grants.nih.gov/grants/guide/pa-files/PA-00-069.html).

3. Minority supplement awards for students and investigators. Minority students and investigators (from high-school level through staff or faculty status) are eligible to enhance their research expertise or develop independent research potential through a Minority Supplement to an already funded NIH grant. The NIH program announcement that describes these awards in detail is located at http://grants.nih.gov/grants/guide/pa-files/PA-99-104.html

NIA-supported programs for minority investigators.

The NIA supports several specific programs to assist in the development of research careers for minority investigators whose research topics are relevant to the NIA mission.

1. Minority dissertation awards. Recognizing that the dissertation stage of a predoctoral career generates unusual expenses that can be beyond the reach of many minority students, the NIA sponsors dissertation awards for needy minority doctoral candidates. These awards provide a stipend and some support for research expenses. Additional information on this program can be found on the NIA Web site (http://grants.nih.gov/grants/guide/pa-files/PAR-98-110.html).

2. Minority add-on slots for institutional training grants. This program permits directors of NIA-supported training grants (T32s) to obtain an additional predoctoral or postdoctoral training slot if an eligible and qualified minority student is identified and no appropriate slots on the training grant are available. The minority student can identify principal investigators and institutions with active T32 training grants supported by the NIA through the NIH CRISP data system (https://www-commons.cit.nih.gov/crisp/). For more information, contact the NIA Training Officer, Dr. Robin A. Barr (rb42h{at}nih.gov).

3. MERIT supplements. NIA MERIT (R37) awardees may request up to $5000 to bring minority investigators (from high-school students through junior faculty) into their laboratory before applying for more long-term funding through the NIH minority supplement program. The minority student can identify active R37 (MERIT) grants supported by the NIA through the NIH CRISP data system (https://www-commons.cit.nih.gov/crisp/).

4. Summer Institute on Aging Research. Each year, the NIA conducts the NIA Summer Institute on Aging Research. This 1-week program offers new researchers intensive exposure to issues and challenges in research on aging. The Summer Institute program includes lectures, seminars, and small group discussions on research design relative to aging, including issues especially relevant to aging of ethnic and racial minorities. Participants can consult with NIA staff and other experts in research on aging to develop their research interests and obtain advice on preparing and submitting research grant applications to the NIA. Travel and living expenses are provided. Current information regarding this annual program and an application form are available at the NIA Web page (http://www.nia.nih.gov/news/calendar.htm).

5. Technical Assistance Workshop. The NIA annually conducts a 2-day workshop immediately before the annual meeting of the Gerontological Society of America. This workshop is intended for postdoctoral and predoctoral students and for other individuals with recent Ph.D.s, M.D.s, or related doctoral degrees. The workshop faculty provide information on and technical assistance with applying for funding from the NIA. Transportation and lodging expenses can be provided. Current information regarding this annual program and the application form are available through the NIA Web site (http://www.nia.nih.gov/news/calendar.htm).

6. Minority travel assistance program for scientific meetings related to the biology of aging. The Biology of Aging Program at the NIA provides travel assistance funds for minority investigators and minority pre- and postdoctoral students and fellows to present their research on the biology of aging at scientific meetings held in the United States. Further information is available on the NIA Web site (http://www.nia.nih.gov/research/extramural/biology/mintravel.htm).

Acknowledgement. I acknowledge and appreciate the comments and suggestions I received during the preparation of this article from several NIA colleagues: Drs. Taylor Harden and Huber Warner and Mr. Doug Dollemore.

February 13, 2002

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