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

一生中多元化社区的健康老龄化 (HANDLS)

• 批准号: 10473351
• 负责人: michele k evans
• 金额: $ 262.94万
• 依托单位: NATIONAL INSTITUTE ON AGING
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10473351
• 关键词: Acceleration; Address; African American; Age; Age Distribution; Age-Years; American; Area; Automobile Driving; Baltimore; Behavioral; Biocompatible Materials; Biological; Biological Factors; Biological Markers; Biology; Blood Chemical Analysis; Blood Vessels; Body Composition; Bone Density; Brain imaging; COVID-19 pandemic; COVID-19 testing; Cardiovascular Diseases; Censuses; Characteristics; Cities; Clinical; Clinical Research; Cognition; Cognitive; Collection; Communities; Complex; DNA Methylation; Data; Development; Discrimination; Disease; Environment; Environmental Exposure; Environmental Risk Factor; Epidemiology; Epigenetic Process; Evaluation; Failure; Gender; Genetic; Genomics; Guidelines; Health; Health Services; Health Status; Hematology; Home; Home visitation; Household; Housing; Human; Image; Impaired cognition; Incidence; Income; Individual; International; Interview; Laboratories; Literature; Longevity; Longitudinal Studies; Measurement; Measures; Medical History; Medical Research; Methodology; Methods; Minority; Molecular; Morbidity - disease rate; Neighborhoods; Neuroanatomy; Occupations; Outcome; Participant; Pathway interactions; Physical Examination; Physical Function; Physical Performance; Poverty; Prevalence; Probability; Probability Samples; Prospective cohort; Protocols documentation; Proxy; Psychology; Psychophysiology; Psychosocial Factor; Questionnaires; Race; Recording of previous events; Renal function; Reporting; Research; Research Design; Risk; Risk Factors; Role; SARS-CoV-2 infection; Sample Size; Sampling; Sensory; Seroprevalences; Services; Site; Smell Perception; Societies; Socioeconomic Status; Surveys; Testing; Thick; Time; Translational Research; Treatment/Psychosocial Effects; Ultrasonography; Vision; Visit; Weight; Work; age difference; age related; base; bone quality; brain health; cohort; demographics; depressive symptoms; design; dietary; endothelial dysfunction; epidemiology study; executive function; extracellular vesicles; financial literacy; follow-up; health care quality; health disparity; health literacy; health service use; healthy aging; heart rate variability; improved; literacy; low socioeconomic status; medical examination; microbiome; molecular marker; mortality; multidisciplinary; muscle strength; novel; nutrition; pandemic disease; pre-clinical; prevent; prospective; psychosocial; racism; recruit; sex; social; social capital; social cohesion; social genomics; sociodemographics; socioeconomics; systemic inflammatory response; telomere; tool

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.

HANDLS研究是一项流行病学、跨学科、纵向研究，以30岁至之间的非裔美国人和白人为代表，通过家庭筛查从巴尔的摩市12个人口普查区段的区域概率样本中招募作为固定队列参与者。HANDLS设计是巴尔的摩基于2000年人口普查的面积概率样本。使用这种方法，与调查统计学家合作，我们选择了13个社区，按照潜在队列的年龄分布满足SES的种族要求，因为它们可能产生巴尔的摩市的代表性分布，具有足够的个人来填补基于抽样设计的基础。在这13个社区中，住房单元的选择机会已知不为零。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那些被包括在样本中。根据这些概率，我们可以计算权重，以调整不相等的选择概率。这些权重将被用来计算结合任何年龄、性别、种族和贫困群体的受试者的估计。根据2004年《卫生和公共服务贫困准则》的125%，贫困状况的分界线是125%的贫困。 在初试和招聘研究中，数据收集分为两部分。第一部分由家庭访谈组成，包括关于参与者健康状况、卫生服务利用、心理社会因素、营养、社区特征和人口统计学的问卷调查。第二部分是在医学研究车上收集的，包括病史和体检、饮食回忆、认知评估、心理生理学评估，包括心率变异性、动脉厚度、颈动脉超声、肌肉力量和骨密度评估，以及实验室测量(血液化学、血液学和生物材料)。使用流动医疗研究车辆，我们将访问每个人口普查地区4个月，我们将在3.5年的周期内重新访问每个人口普查地区。 HANDLS于2009年3月完成了基线审查，最终总应计人数为3720人。这一群体由非裔美国人(59%)和白人(41%)组成。约有41%的人报告家庭收入低于125%的贫困状况分界线。在125%的贫困线以下的人中，13%是白人，28%是非裔美国人。在125%的贫困线以上的人中，28%是白人，31%是非裔美国人。样本的平均年龄在基线时为47.7岁。性别或种族方面没有显著的年龄差异。低于125%贫困分界线的参与者比超过125%贫困分界线的参与者略年轻。HANDLS体检率为75.2%，与国家健康与营养检查研究(NHANES)75%的体检率相当。第三波检查于2009年7月开始，2013年6月完成，显示率为91%。符合纵向研究设计的第3波方案保持了与第1波基线检查相同的许多研究领域，包括：认知、心血管疾病、营养、体能、心理学、卫生服务、基因组学(遗传学和表观遗传学)和疾病的分子生物标记物。该方案还包括新的研究领域，特别侧重于肾功能、神经解剖学、金融和健康素养。第4波从2013年9月至2017年7月进行。第四波方案包括增加Entopat作为内皮功能障碍的衡量标准，还包括对颈动脉内膜厚度的纵向评估，以及认知领域使用不太依赖于识字的衡量标准来评估执行功能。为防止因研究过程中被限制在家中的参与者丢失数据而造成的偏见而制定的回访议定书正在进行中。第五波从2017年9月开始，一直持续到现在，方案中增加了新的内容，包括感觉测试(嗅觉、视力、眼底成像)、微生物组和环境暴露生物材料收集，并继续评估MRV以及家庭中的参与者。 新冠肺炎大流行导致我们向HANDLS添加了一个新的域，该域促进了基于社区的新冠肺炎测试，以及检查新冠肺炎感染和血清阳性的流行率和临床表现，以及大流行的心理社会影响。 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，其他专注于营养、死亡生物标记物、认知、端粒、细胞外小泡、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的研究。