Health Effects of Racial Segregation on Aging Adults

种族隔离对老年人健康的影响

• 批准号: 7143143
• 负责人: JOSEPH J SUDANO
• 金额: $ 20.05万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-30 至 2010-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7143143
• 关键词: Health; Effects; Racial; Segregation; Aging

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.

描述（由申请人提供）：学习目的。健康状况由个人和社区层面的投入决定。种族居住隔离（RRS）是一种旨在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发挥影响的途径尚未得到充分探索。本研究将： 1) 在调整社区和个人层面的影响后，确定若干全球和地方 RRS 措施在解释健康状况变化方面的独立影响； 2) 明确这些 RRS 测量使用社区和个人层面的中介因素影响健康变化的途径和机制； 3) 比较这些 RRS 措施的相对解释力，并确定这些措施的中介机制是否有所不同。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，纳入了约 4690 名白人、1198 名黑人和 590 名年龄在 51 至 61 岁之间的西班牙裔成年人，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 和健康状况之间路径上的经济、社会、身体和卫生系统社区特征制定可操作的措施。我们使用空间和空间测量，包括两组（黑人/白人或西班牙裔/白人）和多群体（白人/黑人/西班牙裔）设计，在全球（即大都市或城市）和地方或人口普查区层面确定。我们的模型中将包含个人层面的社会经济地位、健康行为和慢性病的衡量标准。我们将使用以下基于自我报告的健康结果来检查 RRS 与健康之间的关系： 1) 1992 年至 2002 年期间健康状况大幅下降、无变化或改善； 2) 1992年至2002年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； 4) 1992 年至 2000 年间，a) 流动性、b) 敏捷性或 c) 设施方面身体限制的变化。在控制社区和个人层面的特征后，将使用种族/民族分层分层/多级建模和逻辑回归来评估 RRS 与健康状况之间的关联。种族/族裔分层结构方程模型将用于描绘 RRS、社区和个人层面特征以及健康状况之间的中介途径。意义：当前的提案是首批使用纵向数据探索 RRS 与健康之间潜在因果关系的研究之一。了解这些途径中的中介和调节将增进我们目前对社区层面因素对健康重要性的理解，并将政策决策重新集中在解决健康状况差异的这些根本原因的干预措施的必要性上。