Healthy Aging In Nationally Diverse Longitudinal Samples

通过提出与衰老相关的病理状况的发病率和风险差异的基本问题，研究不同种族、民族和经济来源的群体，我们希望了解环境和遗传风险因素对疾病的重要性。我们已经实施了一项新的研究，健康老龄化在全国不同的纵向样本（HANDLS），以解决这些问题。我们还为这类研究建立了一个新的范例，通过使用移动医疗研究车辆（MRV）前往潜在志愿者居住的地方，使参与的可能性更大。这辆车是一辆47英尺的定制半挂车，有三个工作区：一个带献血站的检查室；心血管健康和肌肉力量测试区；还有一个骨密度和血管研究测试区。HANDLS提出的基本问题是，少数民族和社会经济地位较低的亚群体之间的健康差异是由于社会经济地位的差异、种族的差异还是它们之间的相互作用造成的。HANDLS主要关注脑血管健康、心血管健康以及认知、心理生理学、力量和身体功能的年龄相关变化。采用纵向设计，从巴尔的摩大都会地区的代表性样本，我们正在检查是否有不同的比率和风险的病理条件与衰老有关的社会经济地位和种族的差异。HANDLS的试验阶段于2000年10月开始，其目标是审查利用流动医疗研究车进行社区临床研究的可行性。为此，我们从西巴尔的摩社区招募了一个小样本，年龄在19-88岁之间。迄今为止，已有358名积极参与者。研究领域包括心血管疾病、脑血管疾病、与年龄相关的认知、力量和身体功能变化以及心理生理学。这项研究的试点阶段成功地实现了其主要目标，即评估利用流动医疗研究车开展社区研究的可行性。试点使我们能够在不同的社会经济样本中细化临床研究的后勤要求，重点是几个科学和临床领域。试点的第二个目标是开始收集数据，以扩大我们对非裔美国人社区健康差异的可能原因的理解，以及种族和社会经济地位对健康和与年龄有关的疾病和残疾发展的影响。我们对心理生理学数据的初步分析表明，非裔美国人对某些刺激的血压反应存在重要差异，这可能与血压控制机制的差异有关。此外，我们对情感的初步研究表明，CESD（一种社区居民抑郁症状的标准筛查）测量的抑郁症状率更高。这可能表明，在我们所研究的队列中，抑郁症状的发生率更高，或者表明，这种广泛使用的工具在低社会经济地位和少数群体中筛查的准确性较低。我们目前正在研究这一发现。自应计开始以来，我们已经获得了完成心理任务期间的搏动血压和心脏周期的数据。该任务旨在引出有关情绪感知的信息，包括一个基线生理记录期，随后以平衡顺序对面部情绪图片和情绪描述句子进行评分。这些周期之后是一个与基线周期相同的恢复期。此外，参与者还完成了一系列旨在衡量心理社会功能方面的问卷调查，包括抑郁症。初步数据分析支持非裔美国人心血管恢复延迟的观点，这可能是黑人和白人心血管健康差异的潜在因素。在这个非裔美国人的样本中，血压和心率从基线到面孔任务和从面孔任务到句子任务都有所增加。重要的是，在恢复期血压保持在高位。我们能够检查血压、心输出量和总外周阻力的生理成分，并发现在恢复期外周阻力升高的证据。NIA和IRP研究人员先前的研究表明，非裔美国人的血管高度反应性，目前的结果支持这些先前的发现。然而，在目前的研究中，我们也发现了证据，表明这可能与重要的社会心理因素有关。在整个样本中，抑郁与心血管对任务的反应正相关。此外，在女性中，我们发现抑郁量表中测量孤独的项目与任务的外围抵抗反应之间存在显著的相关性。具体来说，孤独感的增加与血管阻力的增加有关。这些结果强调了系统功能的多个层面可能导致心血管疾病，特别是高血压的非常显著的健康差异。进一步的分析将解决这些发现与心脏周期和血压变异性之间的关系。本研究其他领域的数据分析目前正在进行中，而且还处于初步阶段，无法与本报告一起提交。将该研究从试点（可行性）阶段转移到全面运行阶段的当前挑战是采样框架的设计，该框架要考虑到在巴尔的摩的非裔美国人中开发跨SES阶层的代表性样本的需要，以及在不使研究从操作角度来看不切实际的情况下识别和包括巴尔的摩低SES白人的队列。

By posing fundamental questions about differences in rates and risks for pathological conditions associated with aging, studying groups with diverse racial, ethnic, and economic origins, we hope to understand the significance of environmental and genetic risk factors for disease. We have implemented a new study, Healthy Aging in Nationally Diverse Longitudinal Samples (HANDLS), to address these issues. We have also established a new paradigm for this type for research in making participation more likely by using a mobile medical research vehicle (MRV) to go where potential volunteers live. The vehicle, a 47-foot customized semi-trailer, has three working areas: an examination room with blood donor station; a cardiovascular fitness and muscle strength testing area; and a bone density and vascular studies testing area. The fundamental question posed by HANDLS is whether health disparities among minority and lower socioeconomic status subgroups are due to differences in socioeconomic status, differences in race, or their interaction. HANDLS focuses primarily on cerebrovascular health, cardiovascular health, and age-associated changes in cognition, psychophysiology, and strength and physical functioning. Using a longitudinal design with a representative sample from the Baltimore metropolitan area, we are examining whether there are differences in rates and risks for pathological conditions associated with aging that are associated with differences in socioeconomic status and race. The pilot phase of HANDLS, which began in October 2000, has the goal of the examining the feasibility of doing community-based clinical research in a mobile medical research vehicle. To this end, we have recruited a small sample of convenience from West Baltimore neighborhoods that range in age from 19-88. There are 358 active participants to date. The domains of the study are cardiovascular disease, cerebrovascular disease, age-associated changes in cognition, strength and physical functioning, and psychophysiology. The pilot phase of this study has been successful in addressing its primary goal assessing the feasibility of conducting a community-based study using a mobile medical research vehicle. The pilot has allowed us to refine the logistical requirements for the conduct of clinical research focused on several scientific and clinical domains among a diverse socioeconomic sample. The second goal of the pilot was to begin to collect data that would expand our understanding about the possible causes of health disparities in the African American community and the effect of race and socioeconomic status on health and the development of age-related disease and disability. Preliminary analyses of our psychophysiological data suggests important differences in blood pressure responses to certain stimuli among African American subjects that may be tied to differences in control of mechanisms of blood pressure. In addition our initial studies of affect suggest a higher rate of depressive symptomatology as measured by the CESD, a standard screen for depressive symptoms among community dwelling cohorts. This may suggest either a higher rate of depressive symptoms in the cohort we have studied and/or suggest that this widely used instrument is less accurate for screening in low SES and minority cohorts. We are presently pursuing this finding. Since accrual began we have obtained data on the beat-to-beat blood pressure and heart period during the completion of a psychological task. The task is designed to elicit information concerning the perception of emotion and consists of a baseline physiological recording period followed in counter-balanced order by the rating of pictures of facial emotions and the rating of emotion-descriptive sentences. These periods are followed by a recovery period identical to the baseline period. In addition, participants completed a number of questionnaires designed to measure aspects of psychosocial functioning including depression. Preliminary data analyses support the notion that there is a delay in cardiovascular recovery among African Americans that may be a potential factor in the cardiovascular health disparity between Blacks and Whites. In this sample of African Americans, blood pressures and heart rate increased from the baseline to the faces task and from the faces task to the sentences task. Importantly, during the recovery period blood pressure remained elevated. We were able to examine the physiological components of blood pressure, cardiac output and total peripheral resistance, and found evidence of elevated peripheral resistance during the recovery period. Previous research by NIA and IRP investigators has shown vascular hyper-reactivity among African Americans and the present results support these previous findings. However, in the present study we have also found evidence that this may be associated with important psychosocial factors. In the total sample, depression was positively correlated with cardiovascular reactivity to the tasks. In addition, in females we found a significant correlation between an item on the depression inventory measuring loneliness and the peripheral resistance response to the task. Specifically, increased loneliness was associated with increased vascular resistance. These results serve to highlight the multiple levels of system functioning that may contribute to the very significant health disparity in cardiovascular disease, especially hypertension. Further analyses will address the relationship between these findings and heart period and blood pressure variabilities. Analyses of the data in other domains of this study are currently underway and too preliminary to submit with this report. The current challenge to moving this study from its pilot (feasibility) phase to full operation is the design of the sampling frame that takes into account the need to develop a representative sample across SES strata among African Americans in Baltimore as well as to identify and include low SES whites of Baltimore in the cohort without making the study impractical to do from an operational standpoint.