Abstract
No studies to date have examined support by the National Institutes of Health (NIH) for primary and secondary prevention research in humans and related methods research that measures the leading risk factors or causes of death or disability as outcomes or exposures. To characterize NIH support for such research. This serial cross-sectional study randomly sampled NIH grants and cooperative agreements funded during fiscal years 2012 through 2017. For awards with multiple subprojects, each was treated as a separate project. Study characteristics, outcomes, and exposures were coded from October 2015 through February 2019. Analyses weighted to reflect the sampling scheme were completed in March through June 2019. Using 2017 data from the Centers for Disease Control and Prevention and 2016 data from the Global Burden of Disease project, the leading risk factors and causes of death and disability in the United States were identified. The main outcome was the percentage of the NIH prevention research portfolio measuring a leading risk factor or cause of death or disability as an outcome or exposure. A total of 11 082 research projects were coded. Only 25.9% (95% CI, 24.0%-27.8%) of prevention research projects measured a leading cause of death as an outcome or exposure, although these leading causes were associated with 74.0% of US mortality. Only 34.0% (95% CI, 32.2%-35.9%) measured a leading risk factor for death, although these risk factors were associated with 57.3% of mortality. Only 31.4% (95% CI, 29.6%-33.3%) measured a leading risk factor for disability-adjusted life-years lost, although these risk factors were associated with 42.1% of disability-adjusted life-years lost. Relatively few projects included a randomized clinical trial (24.6%; 95% CI, 22.5%-26.9%) or involved more than 1 leading cause (3.3%; 95% CI, 2.6%-4.1%) or risk factor (8.8%; 95% CI, 7.9%-9.8%). In this cross-sectional study, the leading risk factors and causes of death and disability were underrepresented in the NIH prevention research portfolio relative to their burden. Because so much is already known about these risk factors and causes, and because randomized interventions play such a vital role in the development of clinical and public health guidelines, it appears that greater attention should be given to develop and test interventions that address these risk factors and causes, addressing multiple risk factors or causes when possible.
Highlights
The United States faces numerous public health challenges, from expanding waistlines to opioid overdoses
Because so much is already known about these risk factors and causes, and because randomized interventions play such a vital role in the development of clinical and public health guidelines, it appears that greater attention should be given to develop and test interventions that address these risk factors and causes, addressing multiple risk factors or causes when possible
Levels and Trends of Prevention Research Involving the Leading Risk Factors or Causes of Death and Disability For fiscal years 2012 through 2017, we estimated that 51.4% of National Institutes of Health (NIH)-funded prevention research projects and 50.8% of prevention research dollars measured a leading risk factor or cause of death as an exposure or as an outcome
Summary
The United States faces numerous public health challenges, from expanding waistlines to opioid overdoses. Previous studies[2,3,4,5,6] have examined the association between NIH funding and burden of disease measures, such as mortality. Gillum et al[3] found no association more than 10 years later Those analyses preceded the development of a consistent method to estimate diseasespecific funding levels across the NIH. That method, called the Research, Condition, and Disease Categorization system,[4] was introduced in 2008 and used by Sampat et al,[5] who observed a positive association between US burden of disease and the level of NIH funding. A more recent study[6] reported positive associations between NIH funding and deaths and disability-adjusted life-years (DALYs) in the United States and globally
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