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: 7267669
• 负责人: Michael G Marmot
• 金额: $ 40.47万
• 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 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7267669
• 关键词: Health; disparities; aging; societies; transition

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（由研究者提供）：健康方面的社会差距是一个主要的未解决的公共卫生问题;它们影响整个生命周期的许多健康结果，包括老年人。我们对老龄人口健康的社会差异的理解可以通过在中欧和东欧（CEE）和前苏联（FSU）的研究补充西方国家的研究来加强，利用共产主义垮台后该地区独特的社会和健康状况。中欧和东欧/前苏联的中老年心血管疾病和其他慢性病的死亡率和发病率比西方高得多，现有数据表明，这也适用于与老年人有关的其他结果，如残疾，身体功能下降和认知障碍。将老龄人口健康的社会差异研究扩展到CEE/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淆（因为中欧和东欧/前苏联社会经济指标之间的关联很弱）;可以利用中欧和东欧/前苏联在社会转型期间社会条件和健康状况的巨大变化来解决内分泌问题;并与美国健康与退休研究（HRS）和英国老龄化纵向研究（艾尔莎）等西方研究进行比较。申请的目的是建立在现有的研究心血管疾病在中东欧/前苏联和建立一个纵向研究老龄化的健康，功能，社会地位，经济和心理社会因素的重复测量。本研究的具体目的是：（1）调查国家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）研究国家内的社会差异，以确定对健康最重要的社会经济地位维度;（3）检查将社会经济地位与健康联系起来的行为、心理和生物机制;（4）研究国家间的社会经济地位与健康之间的关系。以及（4）调查健康状况不佳是否与老龄人口社会经济地位下降（内分泌）有关。现有的研究基于俄罗斯、波兰和捷克共和国，包括基线调查和死亡率随访。正在对45-69岁的男女进行随机抽样，收集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。建议开展新一轮的数据收集（第二波），并将立陶宛（作为波罗的海国家的一个例子）列入。研究工具将尽可能与HRS和艾尔莎中使用的工具相同，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。新研究的预计总规模为28，000名受试者。分析将检查横截面结果，基线和第二波之间的健康和功能变化，以及自基线以来CVD和死亡率的发生率。