The Study of Women's Health Across the Nation (SWAN): The Impact of Midlife and the Menopause Transition on Health and Functioning in Early Old Age

项目摘要 这个U19应用程序，被称为天鹅老化，旨在确定在多大程度上中年健康， 特别是绝经过渡期（MT），影响女性的成功衰老。该提案利用 关于全国妇女健康研究（SWAN）的丰富资源，这是一项纵向队列研究 1994年开始，以描述MT期间发生的生理和心理变化。共 3302名黑人、中国人、日本人、西班牙裔和白色妇女在7个地点登记，74%的仍然- 从绝经前到绝经后完成多达16次就诊的在世妇女。天鹅 描述了MT的自然史-它的时间，激素变化的模式和症状-以及它们的 中年健康指标。在SWAN-老龄化研究中，我们将对SWAN队列的随访扩展到早期老年人， 年龄（66 - 75岁），并将前瞻性地将MT和 中年健康指标，以功能和健康在多个领域在老年早期，一个关键的时间， 当健康和功能的不利变化开始积累时，过渡到老年。全球 该U19应用的具体目标是：1）确定MT特征和轨迹的影响， 关于保持认知、身体、泌尿生殖、性和心理社会健康的中年健康指标 功能和睡眠在老年早期; 2）确定的影响MT的特点和轨迹的中年 关于不良健康后果风险的健康指标，包括福尔斯、骨质疏松和骨折， 心血管代谢功能、心血管事件和早期死亡率; 3）确定 老年早期的健康和功能可归因于中年MT特征的种族/民族差异 和中年健康指标;以及4）将SWAN和SWAN-Aging调查结果转化为妇女及其健康 护理提供者。这些目标将通过三个综合科学项目来实现， 围绕关键健康领域（功能、心脏代谢健康和肌肉骨骼健康）， 共同关注MT特征和健康指标的中年变化作为关键暴露。三 项目将得到三个核心的支持，这三个核心将：a）提供必要的组织基础设施， 进行本研究并将结果传播给研究和医学界; B）进行准确， 高容量分析，根据需要采用新方法，以提供最先进的实验室数据，以及c） 监督核心诊所访视的设计和实施、数据收集和数据管理，以及 分析数据集。天鹅老龄化将包括一个诊所访问和国家死亡指数搜索，以确保 完成队列的死亡率确定。天鹅老龄化是独特的定位，以填补重要的科学 在了解中期战略和中年指标对妇女健康和功能的影响方面存在差距， 早期老年，并促进新知识应用于临床实践。本研究将提供 对与未来预防和治疗方案设计相关的可修改因素的宝贵见解。

PROJECT SUMMARY This U19 application, referred to as SWAN-Aging, is designed to determine the extent to which midlife health, and specifically the menopause transition (MT), affects successful aging in women. This proposal capitalizes on the rich resources of the Study of Women's Health Across the Nation (SWAN), a longitudinal cohort study initiated in 1994 to characterize the physiological and psychosocial changes that occur during the MT. A total of 3302 Black, Chinese, Japanese, Hispanic and White women were enrolled at seven sites, with 74% of still- living women completing up to 16 visits spanning the pre-menopause to post-menopause. SWAN has described the natural history of the MT -- its timing, patterns of hormonal changes, and symptoms – and their relation to midlife health indicators. In SWAN-Aging, we will extend follow-up of the SWAN cohort into early old age (66-75 years) and will prospectively link comprehensive longitudinal characterization of both the MT and midlife health indicators to functioning and health across multiple domains in early old age, a pivotal time of transition into old age when adverse changes in health and functioning begin to accumulate. The global specific aims of this U19 application are to: 1) determine the impact of MT characteristics and trajectories of midlife health indicators on the preservation of cognitive, physical, genitourinary, sexual, and psychosocial function and sleep in early old age; 2) determine the impact of MT characteristics and trajectories of midlife health indicators on risk of adverse health outcomes, including falls, osteoporosis and fractures, poor cardiometabolic function, cardiovascular events and early mortality; 3) determine if racial/ethnic disparities in health and functioning in early old age are attributable to midlife racial/ethnic differences in MT characteristics and midlife health indicators; and 4) translate the SWAN and SWAN-Aging findings for women and their health care providers. These aims will be achieved through three integrated scientific Projects that are organized around key health domains (functioning, cardiometabolic health and musculoskeletal health) and linked by a common focus on MT characteristics and midlife changes in health indicators as key exposures. The three Projects will be supported by three Cores which will a) provide the necessary organizational infrastructure to conduct this study and to disseminate results to the research and medical communities; b) conduct accurate, high volume assays, adopting new methods as needed to provide state-of-the-art laboratory data, and c) oversee the design and conduct of the core clinic visit, data collection and data management, and the creation of the analytic datasets. SWAN-Aging will include one clinic visit and a National Death Index search to ensure complete mortality ascertainment for the cohort. SWAN-Aging is uniquely positioned to fill important scientific gaps in understanding of the impact of the MT and midlife indicators on women's health and functioning in early old age and to facilitate the application of new knowledge to clinical practice. This study will provide valuable insights into modifiable factors relevant to the design of future prevention and treatment programs.