Health Effects of Racial Segregation on Aging Adults

描述（由申请人提供）：学习目的。健康状况取决于个人和社区两级的投入。种族居住隔离（RRS）是一种影响健康和健康状况的社区属性。然而，其影响可能与社区及其居民的特征相关并受其调节。RRS对健康的影响程度及其产生影响的途径尚未得到充分探讨。本研究将：1)在调整社区和个人水平的影响后，确定几种全球和地方RRS措施在解释健康状况变化方面的独立效应；2)利用社区和个人水平的中介因素，明确这些RRS措施影响健康变化的途径和机制；3)比较这些RRS指标的相对解释力，并确定这些指标之间的中介机制是否存在差异。方法：来自健康与退休研究的全国代表性数据，这是一项大型前瞻性队列研究，纳入了大约4690名51至61岁的白人、1198名黑人和590名西班牙裔成年人，将与来自地区资源文件和美国人口普查的数据合并。在我们的概念模型的指导下，我们将针对可能位于RRS与健康状况之间的路径上的经济、社会、物理和卫生系统社区特征制定可操作措施。我们使用空间和空间测量，两组（黑人/白人或西班牙裔/白人）和多组（白人/黑人/西班牙裔）设计，确定在全球（即，大都市或城市）和地方或人口普查区水平。个体层面的社会经济地位、健康行为和慢性病的测量将包括在我们的模型中。我们将使用以下基于自我报告的健康结果来检验RRS与健康之间的关系：1)1992年至2002年健康状况明显下降、没有变化或改善；2) 1992年至2002年期间，健康状况大幅下降或死亡，没有变化或改善；3)使用包括死亡在内的自我报告的转换值进行连续测量；1992年至2000年间，a)机动性、b)敏捷性或c)设施的物理限制发生了变化。在控制了社区和个人水平的特征后，将使用种族/民族分层分层/多层次模型和逻辑回归来评估RRS与健康状况之间的关系。种族/民族分层结构方程模型将用于描绘RRS，社区和个人水平特征以及健康状况之间的中介途径。意义：目前的建议是第一个使用纵向数据来探索RRS与健康之间潜在因果关系的研究之一。了解这些途径中的调解和调节将促进我们目前对社区层面因素对健康的重要性的理解，并将重新将政策决定的重点放在需要采取干预措施，解决健康状况差异的这些根本原因上。

DESCRIPTION (provided by applicant): Study Purpose. Health status is determined by inputs at both the individual and community level. Racial residential segregation (RRS) is a community attribute proposed to influence health and health status. Yet its effects may be correlated with and mediated by characteristics of communities and their residents. The extent to which RRS influences health and the pathways through which it exerts effects have not been fully explored. This study will: 1) determine the independent effect of several global and local RRS measures in explaining changes in health status after adjusting for community and individual-level effects; 2) specify pathways and mechanisms by which these RRS measures influence change in health using community and individual level mediating factors; and 3) compare the relative explanatory power of these RRS measures and determine whether the mediation mechanisms vary across these measures. Methods: Nationally representative data from the Health and Retirement Study, a large prospective cohort study of approximately 4690 white, 1198 black and 590 Hispanic adults 51 to 61 years of age at enrollment will be merged with data from the Area Resource File and US Census. Guided by our conceptual model, we will develop operational measures for economic, social, physical and health system community characteristics potentially located on the path between RRS and health status. We use spatial and aspatial measures, both two-group (black/white or Hispanic/white) and multi-group (white/black/Hispanic) design, determined at the global (i.e., metropolitan or city) and the local or census tract level. Measures of individual-level SES, health behaviors, and chronic conditions will be included in our model. We will examine the relationship between RRS and health using the following health outcomes based on self-reports of 1) a major decline, no change, or improvement in health from 1992 to 2002; 2) a major decline or death, no change, or improvement in health from 1992 to 2002; 3) a continuous measure using transformed values of the self-reports including death; and 4) changes in physical limitations in a) mobility, b) agility, or c) facility between 1992 and 2000. Race/ethnicity-stratified hierarchical/multilevel modeling and logistic regression will be used to assess the association between RRS and health status, after controlling for community and individual-level characteristics. Race/ethnicity-stratified structural equation modeling will be used to delineate the mediating pathways between RRS, community and individual-level characteristics, and health status. Significance: The current proposal is one of the first studies to use longitudinal data to explore potential causal pathways between RRS and health. Understanding mediation and moderation in these pathways will advance our current understanding of the importance of community level factors on health and will re-focus policy decisions on the need for interventions that address these fundamental causes of disparities in health status.