Since completing her rheumatology fellowship and research training, Dr. Costenbader has devoted her career to patient-oriented rheumatic disease research. She has served as primary or secondary research mentor for 33 pre- and post-doctoral trainees. Along with her position as Co-Director of the Brigham and Women's Hospital Lupus Center, Dr. Costenbader's mentoring is facilitated by her affiliations with several Harvard teaching and training programs. Moreover, the candidate's multiple ongoing patient-oriented research projects and collaborations, commitment to mentoring, and exceptional institutional resources provide an outstanding environment for the development of junior investigators in patient-oriented rheumatic disease research. This K24 grant would preserve Dr. Costenbader's protected time and relieve future clinical and administrative responsibilities. The new research aims proposed will build upon past work in a large, nationwide lupus population with Medicaid data from 2000-2010. With data on over 66,000 lupus patients in the U.S., these studies will address key unanswered questions about cardiovascular disease risks, medical and surgical care, and outcomes. These important questions include whether cardiovascular disease risks are changing over time in this population, how post-cardiac event and intervention risks compare to those of the general population, whether lupus patients receive optimal cardiac care, and whether hydroxychloroquine reduces cardiovascular disease risks. The inherent sociodemographic variation and high medical risk of this vulnerable population make these studies extremely relevant for ongoing policy discussions about improving healthcare and outcomes. The findings of these powerful studies will inform future . Moreover, the proposed research studies will provide excellent mentoring opportunities. Dr. Costenbader will continue to recruit two to three new trainees into her rheumatic disease epidemiology and outcomes research program each year, and to expand and refine her formal mentoring program using feedback received from trainees, medical care and prescribing practices and seminars and lectures at the Brigham and Women's Hospital and Harvard Medical School. Based on institutional commitment and resources and Dr. Costenbader's successful record in research and mentoring, this K24 grant would greatly augment her ability to expand her existing research mentoring program and to develop the next generation of patient-oriented rheumatic disease investigators.

Public Health Relevance

K. Costenbader K24 application Dr. Costenbader is a recognized patient-oriented investigator in the epidemiology and outcomes of rheumatic diseases, in particular systemic lupus erythematosus and rheumatoid arthritis. She is very dedicated to mentoring the next generation of patient-oriented clinical investigators. Dr. Costenbader's research and mentoring opportunities are enhanced by strong affiliations with research training programs at multiple Harvard teaching hospitals, Harvard Medical School and Harvard School of Public Health, as well as with national research and clinical organizations. The new research proposed on cardiovascular disease risks and outcomes among patients with lupus in the U.S. has enormous public health relevance. Cardiovascular disease is the number one cause of death in the U.S. and despite increased rates among lupus patients, relatively little is known about recent cardiovascular disease event and mortality rates among lupus patients across the U.S., about the types of medical and surgical cardiovascular disease care received, or about outcomes after cardiac procedures for cardiovascular disease. This line of investigations has the potential to provide extremely valuable public health information concerning cardiovascular disease risks and outcomes, and medical and surgical therapies delivered in recent years across the U.S. within a large, nationwide high-risk population. Given strong institutional commitment and resources, as well as her past success in training academic clinical researchers, this K24 will support an expansion of Dr. Costenbader's research and mentoring activities, producing important research findings and well-trained leaders in patient-oriented rheumatic disease research.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Midcareer Investigator Award in Patient-Oriented Research (K24)
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Arthritis and Musculoskeletal and Skin Diseases Special Grants Review Committee (AMS)
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Witter, James
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Brigham and Women's Hospital
United States
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Feldman, Candace H; Costenbader, Karen H; Solomon, Daniel H et al. (2018) Area-level Predictors of Medication Nonadherence among U.S. Medicaid Beneficiaries with Lupus: A Multilevel Study. Arthritis Care Res (Hoboken) :
Barbhaiya, Medha; Feldman, Candace H; Guan, Hongshu et al. (2018) Racial/ethnic variation in stroke rates and risks among patients with systemic lupus erythematosus. Semin Arthritis Rheum :
Broder, Anna; Mowrey, Wenzhu B; Golestaneh, Ladan et al. (2018) Methodological considerations in comparing access to Pre-emptive renal transplantation between SLE and other ESRD causes in the USRDS. Semin Arthritis Rheum :
Feldman, Candace H; Collins, Jamie; Zhang, Zhi et al. (2018) Dynamic patterns and predictors of hydroxychloroquine nonadherence among Medicaid beneficiaries with systemic lupus erythematosus. Semin Arthritis Rheum 48:205-213
MacFarlane, Lindsey A; Kim, Eunjung; Cook, Nancy R et al. (2018) Racial Variation in Total Knee Replacement in a Diverse Nationwide Clinical Trial. J Clin Rheumatol 24:1-5
Feldman, Candace H; Broder, Anna; Guan, Hongshu et al. (2018) Sex Differences in Health Care Utilization, End-Stage Renal Disease, and Mortality Among Medicaid Beneficiaries With Incident Lupus Nephritis. Arthritis Rheumatol 70:417-426
Tedeschi, Sara K; Johnson, Sindhu R; Boumpas, Dimitrios et al. (2018) Developing and Refining New Candidate Criteria for Systemic Lupus Erythematosus Classification: An International Collaboration. Arthritis Care Res (Hoboken) 70:571-581
Lin, Tzu-Chieh; Marmor, Michael F; Barbhaiya, Medha et al. (2018) Baseline Retinal Examinations in Patients With Systemic Lupus Erythematosus Newly Initiating Hydroxychloroquine Treatment in a US Medicaid Systemic Lupus Erythematosus Population, 2000-2010. Arthritis Care Res (Hoboken) 70:1700-1706
Cohen, E M; D'Silva, K; Kreps, D et al. (2018) Arthritis and use of hydroxychloroquine associated with a decreased risk of macrophage activation syndrome among adult patients hospitalized with systemic lupus erythematosus. Lupus 27:1065-1071
Sparks, Jeffrey A; Lin, Tzu-Chieh; Camargo Jr, Carlos A et al. (2018) Rheumatoid arthritis and risk of chronic obstructive pulmonary disease or asthma among women: A marginal structural model analysis in the Nurses' Health Study. Semin Arthritis Rheum 47:639-648

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