Kneipp Shawn M, Schwartz Todd A, Drevdahl Denise J, Canales Mary K, Santacroce Sheila, Santos Hudson P, Anderson Ruth
Shawn M. Kneipp, PhD, RN, APHN-BC, is Associate Professor; and Todd A. Schwartz, DrPH, is Research Associate Professor, School of Nursing, the University of North Carolina at Chapel Hill. Denise J. Drevdahl, PhD, RN, is Professor, Nursing & Healthcare Leadership Program, University of Washington Tacoma. Mary K. Canales, PhD, RN, is Research Consultant, Plattsburgh, New York. Sheila Santacroce, PhD, RN, CPNP, is Associate Professor; Hudson P. Santos Jr, PhD, RN, is Assistant Professor; and Ruth Anderson, PhD, RN, is Professor and Associate Dean for Research, School of Nursing, the University of North Carolina at Chapel Hill.
Nurs Res. 2018 May/Jun;67(3):231-241. doi: 10.1097/NNR.0000000000000278.
The theoretical landscape of health disparities research now emphasizes health inequities and the role that social determinants of health (SDOH) play in creating and perpetuating them. Whether National Institutes of Health (NIH) funding patterns reflect this theoretical shift is unknown.
The aim of this study was to examine the National Institute of Nursing Research's (NINR) funding for research focused on health disparities, health inequities, and SDOH, relative to other key NIH institutes.
Data on 32,968 projects funded by NINR, the National Cancer Institute, the National Heart, Lung, and Blood Institute, and the National Institute of Minority Health and Health Disparities (NIMHD) during the years 2000 through 2016 were downloaded from NIH RePORTER; those with health disparities, health inequity, or SDOH terms used in the abstract were identified. Descriptive statistics and a general linear model approach were used to assess differences in cumulative project counts and funding proportions, and funding trends over time.
Overall, funding for health disparities projects was 14-19 times greater than for health inequity and SDOH projects and was more concentrated in centers and institutional training than in individual research projects. NINR's proportion of funding for disparities projects was consistently greater than that of the National Cancer Institute and the National Heart, Lung, and Blood Institute, but not for inequities and SDOH projects. NIMHD's proportion of funding for disparities, and inequities and SDOH projects (combined) was 2-30 times greater than that of other institutes. Over the 16-year period, funding for disparities, inequity, and SDOH projects each increased (all ps < .05); however, growth in inequities and SDOH funding was not evident in more recent years.
Funding for projects focused on health equities and the SDOH lag behind theoretical shifts in the broader health disparities research arena. With the exception of NIMHD, there is a disconnect between funding for projects with a disparities orientation in institutional training and center projects relative to individual research projects. These trends have implications for nurse scientists seeking NIH funding to support health equity-oriented research.
健康差异研究的理论格局如今强调健康不平等以及健康的社会决定因素（SDOH）在造成和延续这些不平等方面所起的作用。美国国立卫生研究院（NIH）的资助模式是否反映了这一理论转变尚不清楚。
本研究的目的是考察美国国立护理研究所在针对健康差异、健康不平等和健康的社会决定因素的研究方面的资助情况，并与国立卫生研究院其他关键研究所进行比较。
从NIH RePORTER下载了2000年至2016年期间由国立护理研究所、国立癌症研究所、国立心肺血液研究所和国立少数族裔健康与健康差异研究所（NIMHD）资助的32968个项目的数据；识别出摘要中使用了健康差异、健康不平等或健康的社会决定因素等术语的项目。使用描述性统计和一般线性模型方法来评估累计项目数量、资助比例以及随时间的资助趋势的差异。
总体而言，健康差异项目的资助比健康不平等和健康的社会决定因素项目多14至19倍，并且更多地集中在中心和机构培训项目上，而非个人研究项目。国立护理研究所在差异项目上的资助比例始终高于国立癌症研究所和国立心肺血液研究所，但在不平等和健康的社会决定因素项目上并非如此。国立少数族裔健康与健康差异研究所在差异项目以及不平等和健康的社会决定因素项目（合并计算）上的资助比例比其他研究所高2至30倍。在这16年期间，差异、不平等和健康的社会决定因素项目的资助均有所增加（所有p值均<0.05）；然而，近年来不平等和健康的社会决定因素项目的资助增长并不明显。
针对健康公平和健康的社会决定因素的项目资助落后于更广泛的健康差异研究领域的理论转变。除国立少数族裔健康与健康差异研究所外，在机构培训和中心项目中，以差异为导向的项目的资助与个人研究项目的资助之间存在脱节。这些趋势对寻求国立卫生研究院资助以支持健康公平导向研究的护理科学家具有启示意义。
