Cystic fibrosis (CF) is the second most common inherited childhood disease in the United States. CF is commonly thought of as a disease occurring only in whites; however, a third of patients in California are Latino. Latinos with CF have more severe lung disease and are 85% more likely to die annually than non-Latino white CF patients. Risk factors for severe lung function has been well-described in whites with CF, yet little is known about risk factors for severe lung function in Latinos. Our overall hypothesis is that Latinos have worse lung function than non-Latino Whites due to differences in the exposure and impact of risk factors that determine lung function in CF. To test this hypothesis, we will investigate if Latinos acquire different respiratory infections or if infections affect lung function differentially than among non-Latino whites (Aim 1). Maintenance medications improve lung function, but have not been studied specifically in Latinos. We will investigate the impact of these medications in Latinos (Aim 2). However, some important environmental and healthcare- related risk factors for lung function have not been collected by the CF Patient Registry. In our pilot cohort, we will recruit Latino and non-Latino white children with CF to collect data on these potential risk factors: air pollution, secondhand smoke, language spoken, and acculturation (Aim 3). To investigate medication response in Latinos, we will collect data about medical literacy and compliance (Aim 3). I have assembled a team of experienced scientists to address this critically important hypothesis, led by primary mentors Drs. Burchard and Nielson. I am well equipped to successfully accomplish these training and research goals with a foundation of formal training in pediatric pulmonary, pediatric clinical pharmacology, and clinical research and the support of my mentors. In order to become a successful independent investigator in health disparities in cystic fibrosis, I need further training and hands-on experience in the following areas: methods to study health disparities in minority populations; developing and managing a pediatric cohort study; training in advanced biostatistics and study design in CF research; and overall research career development. This proposed research may identify potentially modifiable risk factors that differentially affect lung function in Latinos with CF. Interventions targeting these identified risk factors could improve the health of Latinos with CF, allowing them to have longer and more fulfilling lives. Importantly, this proposed K23 research and training plan will provide me with the essential tools for a successful R01 application and to advance my career in CF research.
Compared to whites, Latinos with cystic fibrosis have more severe pulmonary disease and are more likely to die annually. This health disparity is a growing public health problem as Latinos represent an increasing proportion of cystic fibrosis patients. We propose to investigate potentially modifiable risk factors that may differentially contribute to Latinos with cystic fibrosis having worse pulmonary disease, in an effort to identify potential targets for intervention to improve morbidity and mortality in Latinos.
