LIFE COURSE SES, SOCIAL CONTEXT & CARDIOVASCULAR DISEASE

在本申请1 R 01 HL-64141-01的修订版中， 响应计划公告编号98-098，我们建议确定 社会经济与环境之间强负相关的解释机制 在整个生命过程中的社会经济地位（SES）和心血管疾病发病率， 死亡率，在一个双种族人口为基础的样本的四个美国社区。 将测试各种社会经济地位措施的累积效应和同期效应 对健康结果的预测有效性，考虑到 性别和种族在其（累加或交互）效应方面的差异。 健康结果将包括非侵入性测量的亚临床心血管 疾病，以及致命和非致命的临床疾病表现 在10年的随访过程中确定。早期生命历程 社会经济地位和衡量目前社会经济地位的标准， 生物医学心血管风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，非稳态负荷，和 亚临床和临床疾病。将进行多水平分析， 目标是确定社会经济地位与下列因素相关的途径： 心血管疾病，考虑相关的健康行为，生活方式， 心理社会压力源/支持机制，慢性感染/慢性 炎症负荷、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普查的 社会大环境指标数据资源丰富 社区动脉粥样硬化风险（ARIC）研究，一项基于社区的双种族 基线时年龄在45-64岁之间的男性和女性样本 1987-1989年考试。该队列每三年重新检查一次， 1999年1月，确定了儿童期、成年早期和 在中年，健康相关的行为，许多风险因素的测量， 和亚临床心血管疾病的测量， 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验证的出院信息 10年随访期间累积的诊断和病因特异性死亡率 将提供给本申请中建议的研究。额外 将收集ARIC队列成员的生命历程信息 在研究的第一年。 我们的目标是解释个体的关联和互动效应 社会经济地位属性及其社会背景对发展路径的影响 心血管疾病的个人和群体。更深入地了解 负责这些协会的机制应加强基础， 公共卫生预防措施。

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.