The long-term health effects of the New Deal: An 80 year follow-up of 4 cohorts

7.项目摘要/摘要 关于早期生活、家庭和社区条件对人们的影响有多大，存在很大不确定性 晚年慢性病和衰老。虽然许多关于短期有益影响的研究支持 干预早期生活环境对改善健康的重要性，数据限制阻止了长期的 定期随访研究，因此早期生活政策变化将导致慢性疾病下降的程度 疾病和更健康的衰老尚不清楚。此外，一项实际的社会政策的影响在 对儿童进行评估，这是一种更有机会将这一证据转化为 为当前的社会政策提供信息。我们建议使用四项公认的队列研究，这些研究已经 实现我们的研究目标的优势互补：1)收入动态的小组研究 (PSID)，这是一个具有多代全国代表性的样本；2)美国铝业的数据，它遵循了一个很大的 地理位置不同且有全额保险的制造业工人队列，3)健康与退休研究 (HRS)，它跟踪了具有全国代表性的美国老年人样本，以及4)妇女健康 倡议(WHI)，跟踪一大批妇女。我们将使用这些数据源来检查效果 新政工作救济支出对儿童在大萧条期间成长的长期健康结果的影响 抑郁症。基于我们之前的研究，我们的中心假设是，新政计划带来的就业 将与较低的慢性病水平和较低的死亡率相关，这两个孩子都将受益 家庭，也适用于非受益家庭的儿童，这些家庭生活在获得更多 新政资金。为了验证这一假设，我们提出了以下具体目标：目标1：创建样本 PSID、Alcoa、HRS和WHI数据的概率权重到1940年人口普查样本帧，以启用 跨研究比较并产生具有全国代表性的估计，目标2：估计相关性 父母参与新政工作救济对子女晚年健康和死亡率的影响，目标3：确定 地区级新政支出对儿童晚年健康和死亡率的溢出效应，目标4：检验 父母新政救助参与和区级新政的运行机制 支出与晚年的健康和死亡率有关。我们研究计划的时机至关重要-- 我们现在有机会研究新政工作救济对健康结果的长期影响，因为 这一群体的年龄较大。这可以说是我们理解社会角色的最好机会之一 在整个生命过程中，政策可以在健康老龄化中发挥作用。这些证据将在关键时刻可用，当新的 地方和联邦两级正在考虑支出和基础设施的优先事项，而长期的 人口老龄化带来的疾病负担对医疗费用提出了新的挑战。

7. PROJECT SUMMARY / ABSTRACT There is substantial uncertainty about how important early life household and community conditions are for later life chronic disease and aging. While a number of studies of short-term beneficial impacts support the importance of intervening on the early life environment to improve health, data limitations have prevented long- term follow-up studies, thus the extent to which early life policy changes would lead to declines in chronic disease and healthier aging is unclear. In addition, it is rare that the impacts of an actual social policy in childhood are evaluated, an approach which has clearer opportunities for translation of this evidence for informing current social policy. We propose to use four well established cohort studies that have complementary strengths for accomplishing our study objective: 1) the Panel Study of Income Dynamics (PSID), which is a multi-generational nationally representative sample, 2) the Alcoa data, which follows a large geographically diverse and fully insured cohort of manufacturing workers, 3) the Health and Retirement Study (HRS), which follows a nationally representative sample of older Americans, and 4) the Women's Health Initiative (WHI), which follows a large cohort of women. We will use these data sources to examine the effects of New Deal work-relief spending on the long-term health outcomes of children growing up during the Great Depression. Our central hypothesis, based on our prior research, is that employment from New Deal programs will be associated with lower levels of chronic disease and lower mortality for both the children in benefitting households, but also for children in non-benefit households living in areas that received greater amounts of New Deal funding. To test this hypothesis we propose the following specific aims: Aim 1: Create sample probability weights for PSID, Alcoa, HRS and WHI data to the 1940 census sample frame to enable comparisons across studies and produce nationally representative estimates, Aim 2: Estimate the association of parental New Deal work-relief participation on their children's later life health and mortality, Aim 3: Determine the spillover effect of area-level New Deal expenditures on children's later life health and mortality, Aim 4: Test the mechanisms through which parental New Deal work-relief participation and area-level New Deal expenditures are associated with later life health and mortality. The timing of our research proposal is critical – we now have the opportunity to examine the long-term effects of New Deal work-relief on health outcomes as this cohort reaches older ages. It is arguably one of our best opportunities to understand the role that social policy can play in healthy aging over the life course. This evidence will be available at a critical time when new priorities for spending and infrastructure are being considered at local and federal levels, and the chronic disease burden of an aging population poses new challenges for medical care costs.