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社会经济的不断扩大。 预期寿命和残疾的差异。本应用程序的首要目标是了解 社会经济因素在形成老龄化结果中的作用，创新在于使用多状态 模型（MSM）研究在衰老过程中发生的多种健康事件。很多关于 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（慢性疾病， 多死亡、残疾或死亡），以及这些因素之间的相互关系。 不考虑结果。我们建议使用MSM来检查社会经济因素在 从健康状态到慢性疾病，到随后的多重死亡，到残疾和死亡， 单一的分析框架，使用30年的后续行动，在白厅研究。 我们确定了由于人口老龄化和对其功能影响的认识不足而导致的多发病。 损伤、残疾和死亡对于理解老年人健康方面的社会差距至关重要。的 许多关于多重残疾和残疾的研究具有跨部门性质， 可以用来缩小老年人健康状况的差距。我们的方法 重点关注健康状况随着老龄化的转变或变化，并研究社会经济因素的作用。 以及心理、行为和生物因素如何解释这些方面的社会差异。 过渡。我们的建议是以白厅研究为基础的，白厅研究开创了健康研究的先河 不等式我们建议研究慢性疾病的社会经济差异和潜在机制， 疾病，向多发病和死亡率的转变（AIM 1），检查社会经济因素是否缓冲 多死亡率与残疾之间关系，残疾与死亡率之间的关系，并查明 机制（AIM 2），并评估SES在塑造功能障碍相关性中的作用 （主观和客观评估）与死亡率的关系，及其在终末衰退中的作用，即加速 死亡前功能下降（AIM 3）。 高社会经济群体的预期寿命增加和残疾率降低表明， 有可能改善整个人口的老龄化结果，以确保大多数老年人仍然 健康，积极，独立，尽可能长的时间。为了做到这一点，需要更好地理解 高社会经济地位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.