CHANGES IN HEALTH: SOCIO-ECONOMIC STATUS AND PATHWAYS

在美国、英国和其他工业化国家，死亡率、发病率和卫生功能方面的社会阶层差异依然存在 国家。事实上，在死亡率方面，这一数字可能还在扩大。健康方面存在这样的社会经济(SES)梯度 在整个寿命中，一直持续到第八个十年。健康随年龄的变化是异质性的，重要的 环境决定因素，包括SES。我们将建立健康变化的模式和决定因素 与年龄和社会经济状况的关系。此外，我们将研究个人内部变化的原因和后果 健康随年龄增长不同于横断面研究。在英国的公务员制度中，有一种相反的社会 发病率和死亡率的梯度。白厅第二期研究的长远目标是解释这些问题。 健康方面的社会经济差异。怀特哈尔II研究对10,308名35-55岁的男女公务员进行了调查 在SNTRY(1985-1988)，建立的目的是研究特定的心理社会、生活方式、生物化学和生理的作用 这些因素是这些不平等的可能解释。这些暴露中与年龄相关的真实变化，或累积 纵向测量的暴露，被假设为预测健康的SES差异随年龄的变化。在10点 在队列的一年后续行动中，国家臭氧机构资助收集数据，以重复卫生功能的结果衡量， 便秘功能、代谢综合征的成分和载脂蛋白E基因分型。 这项建议的目的是：1.描述和解释与社会保障体系有关的健康状况随年龄的变化模式。 2.确定从退休前到退休，健康功能的梯度是否不同。3.考生 自尊与认知功能随年龄变化的关系4.研究特定的生物途径 通过检查其随年龄变化的原因和后果来将其联系起来。白厅二号的研究是独一无二的 PO：准备回答这些问题，提供：公务员聘用等级作为衡量社会经济地位的优秀指标； 纵向设计，参与者在进入时相对年轻，允许检测变化的前因； 暴露的重复测量；广泛的暴露数据；检测与年龄相关的变化的强大能力，以及其 与社会经济地位的互动；广泛的健康结果，包括健康和认知功能， 代谢综合征、死亡率、非致命性诊断和疾病缺勤。我们现在申请资金来分析这些数据 到目前为止收集的数据，并对该队列15年后续行动的具体内容作出贡献。借助NIA对 第七阶段，我们将能够在白厅II的基础上继续发展。它将使我们能够积累更多的终端并跟踪健康状况 功能进入老年，将它们与早期生活和中年暴露联系起来，从而使我们能够建立 疾病的心理、社会和生物途径以及健康不平等。 演出S\TG(S)(组织、市、州) 国际卫生与社会中心 流行病学与公共卫生学系 伦敦大学学院 1-1！)托林顿广场 伦敦WC1E 6BT KEY PERSONNEL请参见第11页的说明书。需要使用辅助页以如下所示的格式提供所需的信息。 命名项目上的组织角色 伦敦大学学院迈克尔·马尔莫特教授 (按字母顺序) 伦敦大学学院埃里克·布兰纳博士 文永华大学教授 伦敦大学学院丽贝卡·富勒博士 Jenny Head UCL博士 哈里·海明威博士 保罗·希格斯博士UCL UCL史蒂文·汉弗莱斯教授 首席调查员/主任 协理调查员/高级讲师 顾问/统计学家 副调查员/高级资源科学家 联合调查员/统计师/国家统计局讲师 协理调查员/高级讲师 协作者/讲师 联合调查员/协作者 PHS 35)8(第5/95版)第2页BB 在整个应用程序的底部连续编号页码。Donoj使用后缀，如3a，3b。 首席调查员/项目主任(上一页，中间)：马莫特，迈克尔·吉迪恩 米娜·库马里博士，伦敦大学学院联合研究员/研究员 佩卡·马提卡宁博士对UCL的研究 纪敏女士伦敦大学学院博士生 UCL高级讲师/统计学家Martin Shipley博士 史蒂芬·斯坦斯菲尔德博士，伦敦大学学院联合调查员/联席主任/读者 1 O 问： 0) O 抄送 我 ？ 使用 O O F‘HS39B(第5/9版)第_L页 在整个应用程序中，编号在底部连续翻页。不/使用后缀，如3a，3b。 CC负责人调查员/项目总监(最后、第一、中间)：Marmot，Michael Gideon 在每个打印页面和每个续页上键入首席调查员/项目总监的姓名。(格式说明，请参见 第6页上的说明。) 研究进展 目录 页数 FacePage%1 描述，

Social class differences in mortality, morbidity and health functioning persist in the USA, UK and other industrialized countries. Indeed for mortality they may be widening. Such socioeconomic (SES) gradients in health are present throughout the lifespan persisting into the eighth decade. Changes of health with age are heterogeneous with important environmental determinants, which include SES. We will establish patterns and determinants of change of health in relation to age and SES. Further, we will examine whether the causes and consequences of within-person changes of health with age are different from those found cross-sectionally. In the British civil service there is an inverse social gradient in morbidity and mortality. The broad long term objective of the Whitehall II study is to explain these socioeconomic differences in health. The WhitehallII study of 10 308 male and female civil servants, aged 35-55 years at sntry (1985-1988), was established to examine role of specific psychosocial, lifestyle, biochemical and physiological factors as possible explanations of these inequalities. True age related changes in these exposures, or cumulative exposure measured longitudinally, are hypothesized to predict changes in SES differences in health with age. At the 10 year follow up of the cohort, NIA support funded collection of data to repeat outcome measures of health functioning, costive functioning, components of the metabolic syndrome and ApoE genotyping. The aims of the proposal are: 1. To describe and explain patterns of change with age in health status in relation to SES. 2. To determine if the gradient in health functioning differs from pre-retirement to retirement. 3. To examinethe relationship between SES and change in cognitive function with age. 4. to investigate specific biological pathways linking SES by examining the causes and consequences of their change with age. The Whitehall II study is uniquely po:ised to address these questions, offering: civil service employment grade as an excellent measure of SES; longitudinal design with participants comparatively young at entry allowingthe detection of antecedents of change; repeated measures of exposures; a wide range of exposure data; substantial power to detect age-related change, and its interaction with SES; wide range of health outcomes includinghealth and cognitive functioning, components of the metabolic syndrome, mortality, non-fatal diagnoses and sickness absence. We now request funding to analyze the data collected to date and to contribute to specific elements of the 15year follow-up of the cohort. With NIA support for Phase 7, we will be able to build on Whitehall II. It will enable us to accumulate more endpoints and track health functioning into older age, relate them to early life and mid-life exposures, and thereby allow us to establish psychosocial and biological pathways of disease and health inequalities. PERFORMANCE S\TG(S)(organization, city, state) International Centre for Health & Society DepC of Epidemiology & Public Health University College London 1-1!) Torrington Place London WC1E 6BT KEY PERSONNEL.SeeInstructionson Page 11.Usecontinuationpagesasneededto providetherequiredinformation inthe format shown below. Name Organization Role onProject Professor Michael Marmot UCL (in alphabetical order) Dr Eric Branner UCL Professor Vein Farewell UCL Dr Rebecca Fuhrer UCL Dr Jenny Head UCL Dr Harry Hemingway UCL Dr Paul Higgs UCL Professor Steven Humphries UCL Principal Investigator/ Director Co-Investigator / Senior Lecturer Consultant/Statistician Co-Investigator/Senior Res Scientist Co-Investigator/ Statistician/ SnLecturer Co-Investigator/ Senior Lecturer Collaborator/Lecturer Co-Investigator/Collaborator PHS 35)8 (Rev.5/95) Page 2 BB Number pages consecutively at the bottom throughout the application. Donoj use suffixes such as 3a, 3b. PrincipalInvestigator/ProgramDirector (Last,ffrsl.middle): Marmot, Michael Gideon Dr Meena Kumari UCL Co-Investigator /Research Fellow Dr Pekka Martikainen UCL ResearchFellow Ms Gill Mein UCL Doctoral Fellow Dr Martin Shipley UCL Senior Lect/Statistician Dr Stephen Stansfeld UCL Co-Investigator/Co-Director/Reader 1 O Q 0) O CC i ¿¿ u O O F'HS39B(Rev.5/9S) Page_L Mumber pagesconsecutively al thebottomthroughout the application.Dono/use suffixes suchas3a,3b. CC PrincipalInvestigator/Program Director(Last, first, middle): Marmot, Michael Gideon Typethe name ofthe principalinvestigator/programdirector atthe topofeachprintedpageandeach continuation page.(Fortypespecifications,see instructions onpage 6.) RESEARCHGRANT TABLE OF CONTENTS PageNumbers FacePage 1 description,