Education, socioeconomic status and Aging: transitions from multimorbidity to functional limitations and mortality

项目摘要 最近的数据表明，预期寿命的持续增长伴随着不断扩大的社会经济 预期寿命和残疾方面的差异。这个应用程序的主要目标是理解 社会经济因素在塑造老龄化结果中的作用，创新之处在于使用了多态 研究衰老过程中发生的多种健康事件的模型(MSM)。很多研究都是关于 老龄化使用事件发生时间或生存分析，其中只有一种健康结果(慢性病， 多发病、残疾或死亡)可以一次检查以及它们之间的相互关系 结果不会被考虑。我们建议使用MSM来检查社会经济因素在 从健康状态到慢性病，到随后的多发病，再到残疾和死亡 白厅研究中使用30年跟踪调查的单一分析框架。 我们发现由于人口老龄化和对其对功能的影响缺乏了解而导致的多发病 残疾、残疾和死亡对于了解老年人健康方面的社会差异至关重要。这个 许多关于多发病和残疾的研究的横断面性质不允许进行识别 制定可用于缩小老年人健康状况差距的预防目标。我们的方法 重点关注健康状态随年龄增长的转变或变化，并审查社会经济因素的作用 这些因素以及心理社会、行为和生物因素如何解释这些人的社会差异 过渡。我们的建议是基于白厅的研究，该研究开创了健康研究的先河 不平等。我们建议研究慢性阻塞性肺疾病的社会经济差异和潜在的机制。 疾病、向多发病和死亡率的转变(目标1)，检查社会经济因素是否缓冲 多发病与残疾的关系，以及残疾与死亡率的关系，并确定潜在的 机制(AIM 2)，并评估SES在形成功能障碍关联中的作用 (主观和客观评估)与死亡率及其在最终下降中的作用，即加速下降 死前功能衰退(目标3)。 高社会经济群体的预期寿命延长和伤残率降低表明， 有可能改善整个人口的老龄化结果，以确保大多数老年人留在 尽可能长时间保持健康、积极和独立。为了做到这一点，需要更好地理解 高SES促进老年人健康和功能的途径；证据表明 提案旨在产生。

Project Summary Recent data suggest ongoing increases in life expectancy are accompanied by widening socioeconomic differences in life expectancy and disability. The overarching aim of this application is to understand the role of socioeconomic factors in shaping ageing outcomes, the innovation lies in the use of multi-state models (MSM) to study multiple health events that occur over the course of aging. Much of the research on aging uses time-to-event or survival analysis, where only one health outcome (chronic disease, multimorbidity, disability, or death) can be examined at a time and the inter-relationships among these outcomes are not considered. We propose to use MSM to examine the role of socioeconomic factors in transitions from a healthy state to chronic disease, to subsequent multimorbidity, to disability and death in a single analytic framework using 30-years follow-up in the Whitehall study. We identify multimorbidity due to aging of populations and poor understanding of their impact on functional impairment, disability and death critical to understanding social disparities in health at older ages. The cross-sectional nature of much of the research on multimorbidity and disability does not allow identification of prevention targets that could be used to close the gap in health status of older adults. Our approach focuses on transitions or changes in health states with ageing and examines the role of socioeconomic factors and how psychosocial, behavioral, and biological factors explain social disparities in these transitions. Our proposal is based on the Whitehall study which has pioneered research on health inequalities. We propose to examine socioeconomic disparities and underlying mechanisms in chronic diseases, transitions to multimorbidity and mortality (AIM 1), examine whether socioeconomic factors buffer the association of multimorbidity with disability, and that of disability with mortality and identify underlying mechanisms (AIM 2), and assess the role of SES in shaping the association of functional impairment (subjective and objective assessments) with mortality, and its role in terminal decline, i.e. accelerated decline in function prior to death (AIM 3). Increased life expectancy and reduced disability rates in the high socioeconomic groups suggest that it is possible to improve aging outcomes in the entire population to ensure that most older adults remain healthy, active, and independent for as long as possible. In order to do this, better understanding is needed of the pathways through which high SES promotes health and functioning at older ages; evidence that this proposal aims to generate.