Healthy Aging In Neighborhoods of Diversity Across the Life Span (HANDLS)

HANDLS研究是一项流行病学、跨学科、纵向研究，对30-64岁的非裔美国人和白人的基线代表性样本进行招募，作为一个固定的参与者队列，通过家庭筛查从巴尔的摩市12个人口普查区的区域概率样本中招募。HANDLS设计是基于2000年人口普查的巴尔的摩区域概率样本。使用这种方法，与调查统计学家合作，我们选择了13个社区，以满足种族的社会经济地位的年龄分布的前瞻性队列，因为他们可能会产生代表性的分布巴尔的摩市有足够的个人，以填补抽样设计的基础。 在13个社区中，住房单元被选择为已知的非零选择机会。 这些地址被筛选出符合年龄-性别-种族-贫困样本量的个人，并使用概率抽样方法选择这些人纳入样本。 从这些概率中，我们可以计算权重来调整不相等的选择概率。 需要这些权重来计算将任何年龄-性别-种族-贫困组的联合收割机受试者组合在一起的估计值。根据2004年《卫生和公众服务贫困准则》的125%，贫困状况指数为125%。 在初始检查和招募研究中，分两部分收集数据。第一部分是家庭访谈，包括问卷调查参与者的健康状况，卫生服务利用，心理社会因素，营养，邻里特征和人口统计学。第二部分在医学研究车辆上收集，包括病史和体格检查、饮食回忆、认知评价、心理生理学评估，包括心率变异性、动脉厚度、颈动脉超声检查、肌力和骨密度评估以及实验室测量（血液化学、血液学和生物材料）。我们使用移动的医学研究车辆，对每个普查区进行为期4个月的访问，并将以3.5年为一个周期对每个普查区进行重新访问。 HANDLS于2009年3月完成了其基线检查波，最终共招募了3720名参与者。 该队列由非裔美国人（59%）和白人（41%）组成。 大约41%的同龄人报告家庭收入低于125%的贫困状况。 在125%贫困线以下的人中，13%是白色人，28%是非洲裔美国人。 在125%以上的贫困人口中，28%是白色人，31%是非洲裔美国人。 基线时样本的平均年龄为47.7岁。 没有与性别或种族相关的显著年龄差异。 低于125%贫困线的参与者比高于125%贫困线的参与者略年轻。 HANDLS体检率为75.2%，与国家健康和营养检查研究（NHANES）的75%体检率相当。第三波考试于2009年7月开始，2013年6月完成，显示率为91%。与纵向研究设计一致的第3波方案保持了许多与基线第1波检查相同的研究领域，包括：认知、心血管疾病、营养、体能、心理学、健康服务、基因组学（遗传学和表观遗传学）和疾病的分子生物标志物。 该协议还包括新的研究领域，特别是侧重于肾功能，神经解剖学，财务和健康知识。第4波于2013年9月至2017年7月进行。Wave 4方案包括增加EndoPAT作为内皮功能障碍的指标，颈动脉内膜厚度的纵向评估以及认知领域使用较少依赖于识字的指标来评估执行功能。 正在制定家庭访视方案，以防止在研究过程中因受试者在家而缺失数据而导致的偏倚。第5波于2017年9月开始，并持续到现在，方案增加了新的内容，包括感官测试（嗅觉，视觉，眼底成像），微生物组和环境暴露生物材料收集，并继续在MRV上以及家中评估参与者。 2019冠状病毒病大流行促使我们在HANDLS中增加一个新领域，以促进社区COVID-19检测以及COVID-19感染和血清阳性率的流行率和临床表现以及大流行的心理社会影响的检查。 今年值得注意的发现包括我们继续参与国际遗传联盟的结果，其他研究集中在营养，死亡率的生物标志物，认知，端粒，细胞外囊泡，DNA甲基化，表观遗传年龄加速，大脑健康差异，全身炎症，社会基因组学，大脑成像，抑郁症状，血管生物学，大脑健康和歧视的生物后果。

The HANDLS study is an epidemiologic, interdisciplinary, longitudinal study of a baseline representative sample of African Americans and whites between 30-64 years of age recruited as a fixed cohort of participants by household screenings from an area probability sample of twelve census segments in Baltimore City. The HANDLS design is an area probability sample of Baltimore based on the 2000 Census. Using this methodology, working with survey statisticians we chose 13 neighborhoods to meet race by SES by age distribution of the prospective cohort because they were likely to yield representative distributions of Baltimore City with sufficient individuals to fill the sampling design based. Within the 13 neighborhoods, housing units were selected with a known non-zero chance of selection. The addresses were screened for individuals who meet the age-gender-race-poverty sample size, and those were chosen to be included in the sample using a probability sampling method. From these probabilities, we can compute weights to adjust for unequal probabilities of selection. These weights will be needed to compute estimates that combine subjects across any of the age-gender-race-poverty group. The poverty status delimiter is 125% poverty based on 125% of the 2004 Health and Human Services Poverty Guidelines. In the initial examination and recruitment study data was collected in two parts. The first part consisted of an in-home interview that included questionnaires about the participants health status, health service utilization, psychosocial factors, nutrition, neighborhood characteristics, and demographics. The second part was collected on the medical research vehicles and included medical history and physical examination, dietary recall, cognitive evaluation, psychophysiology assessments including heart rate variability, arterial thickness, carotid ultrasonography, assessments of muscle strength and bone density, and laboratory measurements (blood chemistries, hematology, and biomaterials). Using mobile medical research vehicles, we visit each census tract for 4 months and we will re-visit every census tract in a 3.5-year cycle. HANDLS completed its baseline examination wave in March 2009 with a final total accrual of 3720 participants. The cohort is comprised of African American (59%) and Whites (41%). Approximately 41% of the cohort reported a household income below the 125% poverty status delimiter. Of those below the 125% poverty delimiter, 13% were white and 28% African American. Of those above the 125% poverty delimiter, 28% were white and 31% African American. The mean age of the sample was 47.7 years at baseline. There were no significant age differences associated with sex or race. Participants below the 125% poverty delimiter were slightly younger than those above the delimiter. HANDLS medical examination rate was 75.2% comparable to the 75% examination rate for the National Health and Nutrition Examination Study (NHANES). Wave 3 examinations started in July 2009 and was completed in June 2013 with a show rate of 91%. The Wave 3 protocol in keeping with the longitudinal study design maintained many of the same study domains as the baseline wave 1 examination including: cognition, cardiovascular disease, nutrition, physical performance, psychology, health services, genomics (genetics and epigenetics), and molecular biomarkers of disease. This protocol also included new areas of study particularly focused on renal function, neuroanatomy, financial and health literacy. Wave 4 conducted from September 2013 through July 2017. The Wave 4 protocol included the addition of the EndoPAT as a measure of endothelial dysfunction, longitudinal assessment of carotid intimal thickness as well and the cognitive domain uses measures that are less dependent on literacy to assess executive function. The Home Visit Protocol developed to prevent the bias resulting from missing data from participants who have become home bound over the course of the study is ongoing. Wave 5 began in September 2017 and continues through the present with new additions to the protocol including sensory testing (olfaction, vision, fundal imaging), microbiome and environmental exposure biomaterial collection and continues evaluating participants on the MRVs as well as in the home. The COVID-19 pandemic led us to add a new domain to HANDLS that facilitated community based COVID-19 testing as well as the examination of the prevalence and clinical manifestations of COVID-19 infection and seroprevalence, and the psychosocial effects of the pandemic. Notable findings this year include results from our continued participation in international genetic consortia, other studies focused on nutrition, biomarkers of mortality, cognition, telomeres, extracellular vesicles, DNA methylation, epigenetic age acceleration, brain health disparities, systemic inflammation, social genomics, brain imaging, depressive symptoms, vascular biology, brain health and the biologic outcomes of discrimination.