LIFE COURSE SES, SOCIAL CONTEXT & CARDIOVASCULAR DISEASE

生命历程、社会背景

• 批准号: 6287955
• 负责人: Gerardo Heiss
• 金额: $ 55.93万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-03-01 至 2005-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6287955
• 关键词: African American; atherosclerosis; autonomic disorder; behavioral /social science research tag; cardiovascular disorder epidemiology; caucasian American; chronic disease /disorder; clinical research; disease /disorder proneness /risk; gender difference; health behavior; human data; human middle age (35-64); human subject; life cycle; lifestyle; longitudinal human study; marriage /marital status; metabolism disorder; psychological stressor; questionnaires; racial /ethnic difference; social status; social support network; socioeconomics

In this revision to application 1 R01 HL-64141-01 submitted in response to Program Announcement number 98-098, we propose to identify mechanisms explanatory of the strong inverse association between socioeconomic status (SES) over the life course and cardiovascular disease morbidity and mortality, in a bi-ethnic population-based sample of four U.S. communities. Cumulative and contemporaneous effects of diverse SES measures will be tested for their predictive validity on health outcomes, with consideration of differences by gender and ethnicity in their (additive or interactive) effects. Health outcomes will include non-invasively measured subclinical cardiovascular disease, as well as fatal and non-fatal clinical disease manifestations ascertained over the course of 10 years of follow-up. Earlier life course socioeconomic status and measurements of current socioeconomic status and biomedical cardiovascular risk factors will be integrated with geocoded contemporary social environmental exposures to assess their impact on cardiovascular function, metabolic impairments, allostatic load, and subclinical and clinical disease. Multilevel analyses will be performed with the goal of identifying pathways by which socioeconomic status is related to cardiovascular disease, considering relevant health behavior, life styles, psychosocial stressors/support mechanisms, chronic infection/chronic inflammatory burden, autonomic nervous system dysfunction, and sustained metabolic impairments. The potential modification of the above associations by the social environment will be addressed by these analyses, as well as putative differences by gender and ethnicity. These staged analytic goals are made possible by linking Census-based indicators of the social environment to the rich data resources of the Atherosclerosis Risk in Communities (ARIC) Study, a bi-ethnic, community-based sample of men and women aged 45-64 years at the time of their baseline examination in 1987-1989. This cohort was re-examined every three years through January, 1999 with ascertainment of SES during childhood, early adulthood and in mid-life, health-relevant behaviors, numerous measurements of risk factors, and measures of subclinical cardiovascular disease such as carotid artery wall thickness, arterial distensibility, retinopathy, and lower extremity arterial disease. These data, as well as validated information on hospital discharge diagnoses and on cause-specific mortality accrued over 10 years of follow-up will be made available to the study proposed in this application. Additional life course information on the members of the ARIC cohort will be collected during Year 1 of the study. Our goal is to explicate the associations and interactive effects of individual SES attributes and their social context on pathways of development of cardiovascular disease in individuals and populations. Increased insight into the mechanisms responsible for these associations should strengthen the basis for public health preventive measures.

在本次修订中提交的申请 1 R01 HL-64141-01 响应计划公告编号 98-098，我们建议确定 社会经济之间强逆相关的机制解释 生命历程中的状态（SES）和心血管疾病发病率 死亡率，在美国四个社区的双种族人口样本中。 将测试各种社会经济地位措施的累积和同期效果 其对健康结果的预测有效性，并考虑到 性别和种族的差异（相加或交互）影响。 健康结果将包括非侵入性测量的亚临床心血管疾病 疾病，以及致命和非致命的临床疾病表现 经过10年的跟踪调查才得以确定。早年人生历程 社会经济状况以及当前社会经济状况的衡量标准和 生物医学心血管危险因素将与地理编码相结合 当代社会环境暴露，以评估其对 心血管功能、代谢障碍、稳态负荷和 亚临床和临床疾病。将执行多级分析 确定与社会经济地位相关的途径的目标 心血管疾病，考虑相关的健康行为、生活方式， 社会心理压力源/支持机制、慢性感染/慢性 炎症负担、自主神经系统功能障碍和持续的 代谢障碍。上述关联的潜在修改 这些分析将涉及社会环境以及假定的 性别和种族的差异。 这些分阶段的分析目标是通过将基于人口普查的 社会环境指标丰富的数据资源 社区动脉粥样硬化风险 (ARIC) 研究，一项基于社区的双种族研究 基线时年龄为 45-64 岁的男性和女性样本 1987-1989年考试。该队列每三年重新检查一次 1999 年 1 月，确定儿童期、成年早期和成年期的 SES 在中年，与健康相关的行为，对危险因素的大量测量， 颈动脉壁等亚临床心血管疾病及措施 厚度、动脉扩张性、视网膜病变和下肢动脉 疾病。这些数据以及经过验证的出院信息 诊断和 10 年随访期间累积的特定原因死亡率 将可供本申请中提议的研究使用。额外的 ARIC队列成员的生命历程信息将被收集 在研究的第一年。 我们的目标是阐明个体之间的关联和互动效果 SES属性及其社会背景对发展路径的影响 个人和人群的心血管疾病。增加洞察力 负责这些协会的机制应加强基础 用于公共卫生预防措施。