CHANGES IN HEALTH: SOCIO-ECONOMIC STATUS AND PATHWAYS

健康变化：社会经济地位和途径

• 批准号: 7253105
• 负责人: Michael G Marmot
• 金额: $ 74.49万
• 依托单位: UNIVERSITY COLLEGE LONDON
• 依托单位国家: 美国
• 财政年份: 1996
• 资助国家: 美国
• 起止时间: 1996-04-01 至 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7253105
• 关键词: Address; Affect; Age; Alcohol consumption; Antioxidants; Apolipoprotein E; Award; Behavioral; Biochemical; Biological; Biological Factors; Blood Pressure; British; Cardiovascular Diseases; Cities; Coronary; Data; Data Analyses; Data Collection; Detection; Developed Countries; Diagnosis; Disease; Disease Pathway; Elderly; Elements; Employment; End Point; Epidemiology; Etiology; Female; Funding; Gender; Genetic; Genotype; Gills; Grant; Head; Health; Health Status; Health behavior; Heart; Heart Rate; Hemostatic Agents; Impaired cognition; Inequality; Instruction; Left Ventricular Mass; Life; Life Style; Link; London; Longevity; Marmota; Measures; Mediating; Menopausal Status; Mental disorders; Metabolic syndrome; Mood Disorders; Morbidity - disease rate; N,N-dimethyl-4-(6-benzothiazolylazo)aniline; Names; Numbers; Outcome; Outcome Measure; Participant; Pathway interactions; Pattern; Performance; Persons; Phase; Physiological; Positioning Attribute; Principal Investigator; Psychosocial Factor; Public Health; Range; Rate; Reader; Research; Research Personnel; Retirement; Risk; Risk Factors; Role; Scientist; Services; Social Class; Social support; Societies; Socioeconomic Status; Staging; Universities; Veins; Work; age related; aged; cognitive function; cohort; college; design; disorder risk; follow-up; gene environment interaction; international center; lecturer; male; middle age; mortality; professor; programs; psychosocial; social; social inequality; socioeconomics

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,

在美国、英国和其他工业化国家，死亡率、发病率和健康功能方面的社会阶层差异仍然存在 国家。事实上，就死亡率而言，它们可能正在扩大。健康方面存在这种社会经济（SES）梯度 整个生命周期持续到第八个十年。健康状况随年龄的变化是异质的，重要的是 环境决定因素，其中包括社会经济地位。我们将建立健康变化的模式和决定因素 与年龄和社会经济地位的关系。此外，我们将研究个人内部变化的原因和后果是否 健康状况随年龄的变化与横截面发现的不同。在英国公务员制度中存在着一种逆社会现象 发病率和死亡率的梯度。白厅 II 研究的广泛长期目标是解释这些 健康方面的社会经济差异。 WhitehallII 对 10 308 名年龄在 35 岁至 55 岁之间的男性和女性公务员进行的研究 sntry (1985-1988) 的成立是为了研究特定的社会心理、生活方式、生化和生理的作用 因素作为这些不平等的可能解释。这些暴露的真实年龄相关变化，或累积 纵向测量的暴露量被假设可以预测健康状况中社会经济地位差异随年龄的变化。 10点 对队列进行一年的跟踪，NIA 支持资助数据收集，以重复健康功能的结果测量， 成本功能、代谢综合征的组成部分和 ApoE 基因分型。 该提案的目的是： 1. 描述和解释与 SES 相关的健康状况随年龄变化的模式。 2. 确定退休前与退休后健康功能的梯度是否不同。 3. 检查 SES 与认知功能随年龄变化的关系。 4. 研究特定的生物学途径 通过检查社会经济地位随年龄变化的原因和后果，将社会经济地位联系起来。 Whitehall II 研究是独一无二的 准备解决这些问题，提出： 公务员就业等级作为社会经济地位的一个很好的衡量标准； 纵向设计，参与者在进入时相对年轻，允许检测变化的前因； 重复测量暴露；广泛的暴露数据；检测与年龄相关的变化的强大能力，及其 与 SES 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、非致命诊断和因病缺勤。我们现在请求资金来分析数据 迄今为止收集的数据，并为该队列 15 年随访的具体内容做出贡献。在 NIA 的支持下 第七阶段，我们将能够在 Whitehall II 的基础上进行建设。它将使我们能够积累更多端点并跟踪健康状况 发挥作用到老年，将它们与早年和中年的暴露联系起来，从而使我们能够建立 疾病和健康不平等的心理社会和生物学途径。 绩效 S\TG(S)（组织、城市、州） 国际健康与社会中心 流行病学与公共卫生部 伦敦大学学院 1-1！）托灵顿广场 伦敦 WC1E 6BT 关键人员。请参阅第 11 页上的说明。根据需要使用后续页面以如下所示的格式提供所需信息。 名称 项目中的组织角色 伦敦大学学院迈克尔·马莫特教授 （按字母顺序排列） 埃里克·布兰纳博士伦敦大学学院 Vein教授告别伦敦大学学院 伦敦大学学院丽贝卡·富勒博士 伦敦大学学院珍妮·海德博士 哈里·海明威博士伦敦大学学院 保罗·希格斯博士伦敦大学学院 伦敦大学学院史蒂文·汉弗莱斯教授 首席研究员/主任 联合研究员/高级讲师 顾问/统计学家 联合研究员/高级研究科学家 联合研究员/统计学家/ SnLecturer 联合研究员/高级讲师 合作者/讲师 共同研究者/合作者 PHS 35)8 (Rev.5/95) 第 2 页 BB 在整个申请的底部连续编号页面。 Donoj 使用 3a、3b 等后缀。 首席研究员/项目总监（最后，ffrsl.middle）：Marmot，Michael Gideon Meena Kumari 博士伦敦大学学院联合研究员/研究员 Pekka Martikainen 博士 伦敦大学学院研究员 Gill Mein 女士伦敦大学学院博士研究员 Martin Shipley 博士 伦敦大学学院高级讲师/统计学家 Stephen Stansfeld 博士伦敦大学学院联合研究员/联合主任/读者 1 氧 问 0） 氧 抄送 我 ?? 你 氧 氧 F'HS39B(Rev.5/9S) 第_L页 在整个应用程序的底部连续编号页面。不要/使用后缀，例如 3a、3b。 CC 首席研究员/项目总监（最后、第一、中间）：Marmot、Michael Gideon 在每个打印页和每个后续页的顶部键入主要研究者/项目主管的姓名。（有关键入规范，请参阅 第 6 页上的说明。） 研究补助金 目录 页码 面页1 描述，