Inequality and Disability among Older Adults: Paths to Differential Trajectories

描述(由申请者提供)：这个项目将研究人口、健康、社会经济、行为、心理、支持、结构和背景因素，预测黑人和白人的残疾和死亡率差异，以及在美国最不利的种族群体(黑人)中按性别划分的独特原因。该项目从四个方面扩展了对黑人/白人晚年残疾差异的研究：(1)将使用多种类型的高级定量轨迹分析来检验差异轨迹，并理清对残疾与随时间积累的残疾时间的影响，并使用独特的方法来重新估计模型，以处理选择性死亡；(2)将利用流行病学、女权主义者和其他文献的理论贡献来探索种族之间和种族内的性别差异；(3)除了个人水平因素之外，环境变量在黑人和白人残疾和死亡的因果路径中的作用将被研究；(4)将使用寿命表估计的贝叶斯方法研究黑人/白人预期寿命20年的趋势，这种方法允许直接包括协变量，从而能够直接检验独立影响的假设。我的培训和工作经验为我提供了关于人口老龄化和社会学问题的实质性和方法论知识基础。K99将使我能够扩大这一基础，包括更好地了解多学科框架和处理按种族和性别划分的健康差距的方法，并参加贝叶斯统计和多层次建模的正式培训，以测试背景影响。Roo阶段将给我所需的时间，作为年轻的教师，在我的导师和顾问的指导下完成我的研究计划，并提交一份关于一生中残疾和死亡率方面的种族差异的R01申请。尽管美国老年人的健康状况总体上有所改善，但种族/种族健康差距仍在继续扩大。消除健康差距，包括残疾差异，是2010年健康人的主要重点，而延长活跃寿命是国家老龄研究所使命的首要任务。了解导致残疾差异的因果路径将为解决这些目标的研究和政策提供信息。

DESCRIPTION (provided by applicant): This project will examine demographic, health, socioeconomic, behavioral, psychological, support, structural, and contextual factors predicting disability and mortality differentials for blacks and whites in addition to the unique causal pathways by gender among the most disadvantaged racial group (blacks) in the United States. This project extends the study of black/white disability differentials in later life in four ways: (1) multiple types of advanced quantitative trajectory analyses will be used to examine differential trajectories and disentangle effects on the timing of disability versus accumulation over time and re-estimate models using unique approaches to handle selective mortality; (2) theoretical contributions from epidemiologic, feminist, and other literatures will be drawn on to explore differentials across race and within race by gender; (3) the role of contextual variables in addition to individual-level factors in the causal pathways to disability and mortality for blacks and whites will be examined; (4) 20-year trends in black/ white active life expectancy will be examined using Bayesian methods for life table estimation that allow the direct inclusion of covariates and thus enable direct tests of hypotheses for independent effects. My training and work experiences have provided me a substantive and methodological knowledge base in demography of aging and sociological issues. A K99 would allow me to expand this base to include a greater understanding of multidisciplinary frameworks and approaches to health disparities by race and gender and to participate in formalized training in Bayesian statistics and multilevel modeling for the testing of contextual effects. The ROO phase would allow me the time needed, as young faculty, to complete my research plan under the guidance of my mentors and consultants, and submit an R01 application on racial disparities in disability and mortality over the life course. Although the health of older Americans has been improving on the whole, racial/ethinic health disparities continue to grow. Eliminating health disparities, including differentials in disability, is a major focus of Healthy People 2010 and extending active life is primary to the mission of the National Institute on Aging. Understanding the causal pathways leading to disability differentials would inform research and policy addressing these goals.