ABSTRACT Building upon the strength of existing collaborations and leveraging the intellectual resources and infrastructure across three major research institutions, two in Detroit (Wayne State University and the Henry Ford Health System) and one in Cleveland (Case Western Reserve University/University Hospitals), the ACHIEVE GREATER Center will, i) increase reach in areas with extreme social vulnerability by deploying a suite of community engagement resources in census tracts with heightened social vulnerability, ii) implement, evaluate and maintain an upscaled version of an evidence-based community health worker intervention to control multi-comorbid chronic cardiometabolic diseases by addressing multiple levels of influence across different domains, and iii) foster a diverse workforce of well-trained, early-career stage investigators who collectively focus on alleviating chronic cardiovascular disease disparities that drive U.S. lifespan inequality. In addition to conducting a pilot grants program across the three partnering institutions, ACHIEVE GREATER will perform three distinct but closely related special projects that focus on interrupting early stages of pathogenesis in different contexts (e.g., mobile health units versus fixed community locations). Importantly, this work will be nested in a larger epidemiologic study of multi-level cardiometabolic risk factors. Our team will develop a distributed Cloud-based database complete with a customized set of informatics tools that will enable investigators in the heart of each city to robustly profile multi-level risk factors across different domains using both publicly available information and investigator- generated data. Our evidence-based intervention pathways are designed to control risk factors, especially elevated blood pressure, which is the most important modifiable contributor to heart disease - far and away the leading cause of death in our region. By increasing reach in census tracts with increased social vulnerability where lifespan disparities and uncontrolled cardiometabolic risk factors are most prevalent, our study design optimizes both recruitment opportunities and potential intervention impact. Moreover, the alignment of resources across three institutions will efficiently enhance regional coordination, while increasing the number and diversity of research participants and highly trained early-career stage disparities investigators. If we are successful and cost-effective, then we will have demonstrated a scalable means of improving future lifespan equality by prioritizing risk factor control in high-risk populations from areas with extreme social vulnerability.

NARRATIVE Compelling evidence indicates that the key to increasing lifespan equality is saving lives at ages below ~70 years. The ACHIEVE GREATER Center is designed to do just that by ameliorating cardiometabolic health disparities during early phases of pathogenesis in order to improve Black-White lifespan inequality in two uniquely comparable, densely populated, and severely affected cities: Detroit, MI, and Cleveland, OH.