Health disparities and aging in societies in transition

转型社会中的健康差距和老龄化

• 批准号: 6754917
• 负责人: Michael G Marmot
• 金额: $ 45.41万
• 依托单位: UNIVERSITY COLLEGE LONDON
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-08-15 至 2009-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6754917
• 关键词: Commonwealth of Independent States; Europe; Poland; aging; behavioral /social science research tag; cardiovascular disorder epidemiology; clinical research; culture; functional ability; health disparity; health surveys; human middle age (35-64); human mortality; human old age (65+); human subject; longitudinal human study; psychological aspect of aging; psychological tests; quality of life; questionnaires; social class; social psychology; socioeconomics

DESCRIPTION (provided by investigator): Social disparities in health are a major unsolved public health problem; they affect many health outcomes throughout the lifespan, including the elderly. Our understanding of social disparities of health in aging populations can be enhanced by complementing studies in western countries by studies in Central and Eastern Europe (CEE) and the former Soviet Union (FSU), taking advantage of the unique set of social and health conditions in the region after the fall of communism. Mortality and morbidity from CVD and other chronic diseases at middle and older ages are much higher in CEE/FSU than in the West, and available data suggest that this is also true for other outcomes pertinent to older ages, such as disability, decline in physical functioning and cognitive impairment. Extending research on social disparities in the health of aging populations into CEE/FSU will break confounding due to inter-correlation between socioeconomic factors present in western data (as associations between socioeconomic indicators are weak in CEE/FSU); the questions of endogeneity can be addressed, using the dramatic temporal changes in social conditions and health status that have taken place in CEE/FSU during the societal transformation; and comparisons with western studies, such as the US Health and Retirement Study (HRS) and the English Longitudinal Study of Aging (ELSA), will be conducted. The objective of the application is to build on an existing study of CVD in CEE/FSU and to establish a longitudinal study of aging with repeated measurements of health, functioning, social position, economics and psychosocial factors. The specific aims of the proposed study are: (1) to investigate disparities in CVD and aging related health outcomes between countries and their relation with macro-economic factors; (2) to study social disparities within countries in order to identify the dimension(s) of socioeconomic position that are most important for health; (3) to examine behavioral, psychosocial and biological mechanisms linking socioeconomic position and health; and (4) to investigate whether poor health is associated with decline in socioeconomic status in aging populations (endogeneity). The existing study is based in Russia, Poland and the Czech Republic, and consists of a baseline survey and mortality follow up. Baseline data on socioeconomic and psychosocial factors, nutrition, alcohol and biological samples are being collected on random samples of men and women 45-69 years old. It is proposed to conduct a new wave of data collection (Wave II) and to add Lithuania (as an example of a Baltic country). As far as possible, the study instruments will be identical to those used in HRS and ELSA, focusing on functioning and disability, cognition, quality of life, socioeconomic position, economics, and psychosocial factors. The expected total size of the new study is 28,000 subjects. Analyses will examine cross-sectional outcomes, changes in health and functioning between the baseline and Wave II, and incidence of CVD and mortality since the baseline.

描述(由调查人员提供)：健康方面的社会差距是一个尚未解决的重大公共卫生问题；它们影响包括老年人在内的一生中的许多健康结果。我们可以通过补充西方国家在中东欧(CEE)和前苏联(FSU)的研究，利用共产主义垮台后该地区独特的一套社会和健康状况，来加强我们对老龄化人口健康社会差异的理解。中老年地区的心血管疾病和其他慢性病的死亡率和发病率远高于西方，现有数据表明，与老年人相关的其他结果也是如此，如残疾、身体功能下降和认知障碍。将关于老龄化人口健康方面的社会差异的研究扩展到中欧和东欧/FSU，将打破由于西方数据中存在的社会经济因素之间的相互关联而造成的混乱(因为在CEE/FSU中社会经济指标之间的关联很弱)；内生性问题可以利用中东欧/FSU在社会转型期间社会条件和健康状况发生的戏剧性时间变化来解决；将与西方研究，如美国健康和退休研究(HRS)和英国老龄化纵向研究(ELSA)进行比较。该应用程序的目的是在中欧和东欧/FSU现有的心血管疾病研究的基础上，建立一项关于老龄化的纵向研究，反复测量健康、功能、社会地位、经济和心理社会因素。这项研究的具体目的是：(1)调查国家之间心血管疾病和老龄化相关健康结果的差异及其与宏观经济因素的关系；(2)研究国家内部的社会差异，以确定社会经济地位对健康最重要的维度(S)；(3)研究将社会经济地位与健康联系起来的行为、心理社会和生物学机制；以及(4)调查健康不良是否与老龄人口社会经济地位的下降有关(内生性)。现有研究以俄罗斯、波兰和捷克共和国为基础，由基线调查和死亡率跟踪组成。关于社会经济和心理社会因素、营养、酒精和生物样本的基线数据正在从45-69岁的男性和女性的随机样本中收集。建议开展新一波数据收集(第二波)，并增加立陶宛(作为波罗的海国家的一个例子)。研究工具将尽可能与HRS和ELSA中使用的工具相同，重点关注功能和残疾、认知、生活质量、社会经济地位、经济学和心理社会因素。这项新研究的预期总规模为2.8万名受试者。分析将审查横断面结果、基线和第二波之间的健康和功能变化，以及自基线以来的心血管疾病发生率和死亡率。