Does NIH funding differ between medical specialties? A longitudinal analysis of NIH grant data by specialty and type of grant, 2011-2020

OBJECTIVES

Differences in National Institutes of Health (NIH) funding between specialties may affect research and patient outcomes in specialties that are less well funded.The aim of this study is to evaluate how NIH funding has been awarded by medical specialty. This study assesses differences and trends in the amount of funding, by medical specialty, for the years 2011-2020, via a retrospective analysis of data from the NIH RePORTER (Research Portfolio Online Reporting Tools Expenditures and Results).

STUDY DESIGN

Longitudinal cross-sectional study SETTING: NIH RePORTER data from 2011 to 2020 for awarded NIH grants (F32, T32, K01, K08, K23, R01, R03, R21, U01, P30) in the following medical specialties: anaesthesiology, dermatology, emergency medicine, family medicine, internal medicine, neurology, neurosurgery, obstetrics and gynaecology, ophthalmology, orthopaedic surgery, otolaryngology, pathology, paediatrics, physical medicine and rehabilitation, plastic surgery, psychiatry, radiation-diagnostic/oncology, surgery, and urology.

PARTICIPANTS

NIH grant awardees for the years 2011-2020 INTERVENTION: None PRIMARY AND SECONDARY OUTCOME MEASURES: The following measures were studied: (1) number of grants by specialty, (2) number of grants per active physician in each specialty, (3) total dollar amount of grants by specialty, (4) total dollar amount of grants per active physician in each specialty and (5) mean dollar amount awarded by specialty for each grant type. We investigated whether any of these measures varied between medical specialties.

RESULTS

In general, internal medicine/medicine, psychiatry, paediatrics, pathology and neurology received the most grants per year, had the highest number of grants per active physician, had the highest total amount of funding and had the highest amount of funding per active physician, whereas fields like emergency medicine, plastic surgery, orthopaedics, and obstetrics and gynaecology had the lowest. The mean dollar amount awarded by grant type differed significantly between specialties (p value less than the Bonferroni-corrected alpha=0.00029).

CONCLUSIONS

NIH funding varies significantly between medical specialties. This may affect research progress and the careers of scientists and may affect patient outcomes in less well funded specialties.

Contribution of Common Genetic Variants to Familial Aggregation of Disease and Implications for Sequencing Studies

Despite genetics being accepted as the primary cause of familial aggregation for most diseases, it is still unclear whether afflicted families are likely to share a single highly penetrant rare variant, many minimally penetrant common variants, or a combination of the two types of variants. We therefore use recent estimates of SNP heritability and the liability threshold model to estimate the proportion of afflicted families likely to carry a rare, causal variant. We then show that Polygenic Risk Scores (PRS) may be useful for identifying families likely to carry such a rare variant and therefore for prioritizing families to include in sequencing studies with that aim. Specifically, we introduce a new statistic that estimates the proportion of individuals carrying causal rare variants based on the family structure, disease pattern, and PRS of genotyped individuals. Finally, we consider data from the MelaNostrum consortium and show that, despite an estimated PRS heritability of only 0.05 for melanoma, families carrying putative causal variants had a statistically significantly lower PRS, supporting the idea that PRS prioritization may be a useful future tool. However, it will be important to evaluate whether the presence of rare mendelian variants are generally associated with the proposed test statistic or lower PRS in future and larger studies.

Multiple members in a family can be diagnosed with the same disease. In such families, genetics may be a significant factor in disease risk. However, it remains unclear whether such familial aggregation of disease is likely due to a single highly penetrant rare variant (HPRV), many minimally penetrant common variants, or a combination of the two types of variants. We therefore use recent estimates of SNP heritability and the liability threshold model to estimate the proportion of afflicted families likely to carry a rare, causal variant. We then show that Polygenic Risk Scores (PRS) may be useful for identifying families likely to carry such a rare variant and introduce a related statistic that can be used to select families for sequencing studies trying to identify HPRV.

A signature of circulating inflammatory proteins and development of end-stage renal disease in diabetes

Chronic inflammation is postulated to be involved in development of end stage renal disease (ESRD) in diabetes, but which specific circulating inflammatory proteins contribute to this risk remains unknown. To study this we examined 194 circulating inflammatory proteins in subjects from three independent cohorts with Type 1 and Type 2 diabetes. In each cohort we identified an extremely robust Kidney Risk Inflammatory Signature (KRIS) consisting of 17 novel proteins enriched for TNF Receptor Superfamily members that was associated with a 10-year risk of ESRD. All these proteins had a systemic, non-kidney source. Our prospective study findings provide strong evidence that KRIS proteins contribute to the inflammatory process underlying ESRD development in both types of diabetes. These proteins may be used as new therapeutic targets, new prognostic tests for high risk of ESRD and as surrogate outcome measures where changes in KRIS levels during intervention can reflect the tested therapy’s effectiveness.

Proteomic profiling of circulating proteins in subjects from three independent cohorts with type 1 and type 2 diabetes, identified an extremely robust inflammatory signature, consisting of 17 proteins enriched for TNF Receptor Superfamily members that was associated with a 10-year risk of end-stage renal disease.