LIFE COURSE SES, SOCIAL CONTEXT & CARDIOVASCULAR DISEASE

在对申请1 R01 HL-64141-01的此修订中，提交于 响应项目公告编号98-098，我们建议确定 解释社会经济与社会经济之间强反关联的机制 生活状态(SES)与心血管疾病发病率和 死亡率，在以两个种族人口为基础的美国四个社区的样本中。 将测试不同SES措施的累积和同时影响 他们对健康结果的预测有效性，并考虑到 性别和种族在其(相加或交互)影响方面的差异。 健康结果将包括非侵入性测量的亚临床心血管疾病 疾病，以及致命性和非致命性临床疾病表现 在10年的跟踪调查过程中得到证实。较早的生命历程 社会经济状况和对当前社会经济状况的衡量 生物医学心血管风险因素将与地理编码整合 评估其影响的当代社会环境暴露 心血管功能、代谢损伤、不平衡负荷和 亚临床和临床疾病。将通过以下方式执行多级别分析 确定与社会经济地位有关的途径的目标 心血管疾病，考虑相关的健康行为，生活方式， 心理社会应激源/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性 新陈代谢障碍。可能通过以下方式修改上述关联 社会环境将通过这些分析来解决，以及假设 性别和种族的差异。 这些阶段性分析目标通过将基于人口普查的 社会环境指标对数据资源的丰富性 社区动脉粥样硬化风险(ARIC)研究，一项以社区为基础的双种族研究 年龄为45岁的男性和女性样本--基线时的 1987-1989年的考试。这一队列每三年重新检查一次，直到 1999年1月，确定儿童、成年早期和成年期间的社会经济状况 在中年，与健康相关的行为，对风险因素的大量测量， 以及亚临床心血管疾病的测量，如颈动脉壁 厚度、动脉扩张性、视网膜病变和下肢动脉 疾病。这些数据，以及关于医院出院的有效信息 经过10年的随访，累积了诊断和特定原因的死亡率 将提供给本申请书中提议的研究。其他内容 将收集ARIC队列成员的生命历程信息 在研究的第一年。 我们的目标是阐明个体之间的联系和相互作用 社会经济的属性及其发展路径上的社会语境 个人和人群中的心血管疾病。更深入地了解 负责这些协会的机制应加强基础 用于公共卫生预防措施。

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.