Healthy Aging In Neighborhoods of Diversity Across Life

生活多样性社区的健康老龄化

• 批准号: 6969295
• 负责人: michele k evans
• 金额: --
• 依托单位: NATIONAL INSTITUTE ON AGING
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/6969295
• 关键词: African American; aging; behavioral /social science research tag; biomarker; cardiovascular disorder; caucasian American; cerebrovascular disorders; clinical research; cognition; epidemiology; functional ability; health care service utilization; health disparity; human middle age (35-64); human subject; longevity; longitudinal human study; medical outreach /case finding; mobile health units; nutrition; nutrition related tag; oxidative stress; psychological aspect of aging; racial /ethnic difference; socioeconomics

The National Institute on Aging (NIA) Intramural Research Program (IRP) has been long interested in the cellular and molecular mechanisms of normative aging and age-related disease development. The program has pursued basic laboratory and longitudinal clinical research in normative aging to address these interests. NIA intramural investigators have expanded the program's capacity to address hypotheses about aging and health disparities in minority and poor populations. By posing fundamental questions about differences in rates and risks for pathological conditions associated with aging, studying groups with diverse racial, ethnic, and economic origins, IRP clinical researchers hope to understand the significance of environmental and genetic risk factors for disease. The need to understand the driving factors behind persistent black-white health disparities in overall longevity, cardiovascular disease, and cerebrovascular disease, has led to the effort to develop and plan the NIA IRP Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) study is a community-based, epidemiologically driven research effort designed to focus on evaluating health disparities in socioeconomically diverse African Americans and whites in Baltimore. This study is unique because it is a multidisciplinary project that assesses physical parameters as well as evaluating genetic, biologic, demographic, psychosocial, and psychophysiological parameters of Black and White participants in higher and lower socioeconomic status (SES) over a 20-year period. It also employs novel research tools, mobile medical research vehicles to improve participation rates and retention among non-traditional research participants. The initial examination and recruitment phase will take approximately 3 years to complete. The study data will be collected in two parts. The first part consists of an in-home interview that includes questionnaires about the participant's health status, health service utilization, psychosocial factors, nutrition, neighborhood characteristics, and demographics. The second part will be collected on the medical research vehicles and includes medical history and physical examination, dietary recall, cognitive evaluation, psychophysiology assessments including heart rate variability, arterial thickness, carotid ultrasonography, assessments of muscle strength and bone density, and laboratory measurements (blood chemistries, hematology, biomarkers of oxidative stress and biomaterials for genetic studies The HANDLS study is a multidisciplinary, prospective epidemiologic longitudinal study examining the influences and interaction of race and SES on the development of cardiovascular and cerebrovascular health disparities among minority and lower SES subgroups. The baseline HANDLS sample will consist of approximately 4,000 community-dwelling African American and white adults aged 30-64. Participants are being drawn from 12 pre-determined census tracts in Baltimore City, sampling representatively across a wide range of socioeconomic and income circumstances. The heuristic study design is a factorial cross of four factors: age, sex, race, and SES with approximately equal numbers of subjects per "cell." HANDLS is planned as a 20-year longitudinal study. Using our mobile medical research vehicles, we will visit each census tract for 3 months and we will re-visit every census tract in a 3-year cycle. The 12 census tracts identified were selected because they are likely to yield representative distributions of individuals between 30 and 64 years old who are African Americans and whites, men and women, and lower and higher SES. Individuals calling themselves multi-ethnics will be included and categorized by the group with which they most strongly identify, but their multi-ethnic identification will be recorded for subsequent statistical analyses. Multi-ethnic individuals who identify strongly with neither African Americans nor whites will be excluded from the present study. Initial estimates based on the 2000 census data indicate that we will need to visit approximately 35% of the households in each census tract to collect the required 333 individuals. The initial sample of 4,000 participants is based on power analyses and assumptions about attrition over 20 years. For a power of 80% (the likelihood of finding an effect if it is really present), we can identify moderate effects (magnitude of the differences between groups) for various outcomes with as few as 30 participants per group at the end of the study. Working backwards by assuming 20% attrition after the baseline assessment and 15% attrition between subsequent assessments, we need approximately 4,000 participants at baseline to yield 1,680 after 20 years. The recruitment phase and initial examination will take approximately 3 years to complete. The study has completed a pilot phase that was conducted in two waves (October 2000-December 2001 and February 2003-November 2003). The epidemiologic phase of the study began in August 2004 with a field based dress rehearsal, currently in progress. The full study will begin on November 1, 2004 in the Reservoir Hill area of Baltimore. Covariates-- Other variables such as nutrition, environment and neighborhood effects, genetic make-up, family history, activity level, access to health care, and prevalent medical, dental, psychiatric conditions, oxidative stress, and DNA repair capacity may modulate the effects of SES and race on cardiovascular, musculoskeletal, cognitive, and autonomic functioning. For example: The nutritional domain of the study will examine the effects of race socioeconomic status (SES) on nutritional status and identify nutritional factors that may contribute to health disparity in cardiovascular and cerebrovascular health and cognitive function. The biomarkers domain of the study will examine possible biologic covariates of health disparities and aging. The early appearance and increased severity of age-associated disease among African Americans and low SES individuals suggests that the factors contributing to the emergence of health disparities may also induce a phenotype of 'premature aging' or "accelerated agin". While we do not posit that health disparities result from genetic alterations in genes associated with the known heritable progeroid syndromes. We do hypothesize that in low SES populations with high rates of early onset age-associated disease the interaction of biologic, psychosocial, socioeconomic and environmental factors may result in a phenotype of accelerated aging biologically similar to these syndromes with increased susceptibility to oxidative stress, premature accumulation of oxidative DNA damage, defects in DNA repair and higher levels of biomarkers of oxidative stress. Health disparities therefore, may be the end product of this complex interaction in populations at high risk. HANDLS will examine this hypothesis by measuring biomarkers of oxidative stress, assessing levels of the most widely studied oxidative DNA adduct, and measuring DNA repair capacity in study participants. Prospectively measuring biomarkers of oxidative stress in a longitudinal study may clarify whether oxidative stress plays a pivotal role in aging and in the development and or progression of age associated disease. It may also provide insights into the different trajectories of aging observed in individuals.

美国国家老龄化研究所 (NIA) 校内研究计划 (IRP) 长期以来一直对正常衰老和与年龄相关的疾病发展的细胞和分子机制感兴趣。该计划致力于规范老龄化的基础实验室和纵向临床研究，以满足这些兴趣。 NIA 内部调查人员扩大了该项目的能力，以解决有关少数族裔和贫困人口老龄化和健康差异的假设。通过提出与衰老相关的病理状况的发生率和风险差异的基本问题，研究不同种族、民族和经济来源的群体，IRP 临床研究人员希望了解环境和遗传风险因素对疾病的重要性。由于需要了解黑人与白人在总体寿命、心血管疾病和脑血管疾病方面持续存在的健康差异背后的驱动因素，因此我们努力开发和规划 NIA IRP 在整个生命周期多样性社区中的健康老龄化 (HANDLS) 研究，这是一项以社区为基础、流行病学驱动的研究工作，旨在重点评估社会经济多样化的非洲裔美国人和白人的健康差异 巴尔的摩。这项研究的独特之处在于它是一个多学科项目，评估了 20 年来社会经济地位 (SES) 较高和较低的黑人和白人参与者的身体参数以及遗传、生物学、人口统计学、心理社会和心理生理学参数。它还采用新颖的研究工具、移动医学研究工具来提高非传统研究参与者的参与率和保留率。初步审查和招聘阶段大约需要3年时间才能完成。研究数据将分两部分收集。第一部分包括家庭访谈，包括有关参与者的健康状况、卫生服务利用、心理社会因素、营养、邻里特征和人口统计的调查问卷。第二部分将在医学研究车辆上收集，包括病史和体格检查、饮食回忆、认知评估、心理生理学评估（包括心率变异性、动脉厚度、颈动脉超声检查、肌肉力量和骨密度评估）以及实验室测量（血液化学、血液学、氧化应激生物标志物和用于遗传研究的生物材料） HANDLS 研究是一项多学科、前瞻性流行病学纵向研究，研究种族和社会经济地位对少数群体和较低社会经济地位亚群体心脑血管健康差异发展的影响和相互作用。 基线 HANDLS 样本将由大约 4,000 名居住在社区的 30-64 岁非裔美国人和白人成年人组成。参与者是从巴尔的摩市 12 个预先确定的人口普查区中抽取的，在广泛的社会经济和收入状况下进行了代表性抽样。启发式研究设计是四个因素的因子交叉：年龄、性别、种族和社会经济地位，每个“细胞”的受试者数量大致相等。 HANDLS 计划作为一项为期 20 年的纵向研究。使用我们的移动医疗研究车辆，我们将访问每个人口普查区 3 个月，并将以 3 年为周期重新访问每个人口普查区。 选择确定的 12 个人口普查区域是因为它们很可能产生 30 至 64 岁之间非裔美国人和白人、男性和女性、以及较低和较高社会经济地位的个体的代表性分布。自称为多种族的个人将被纳入并按他们最强烈认同的群体进行分类，但他们的多种族认同将被记录下来以供后续统计分析。既不强烈认同非裔美国人也不认同白人的多种族个体将被排除在本研究之外。 根据 2000 年人口普查数据的初步估计表明，我们需要走访每个人口普查区约 35% 的家庭才能收集所需的 333 人。 4,000 名参与者的初始样本是基于功效分析和 20 年来的人员流失假设。对于 80% 的功效（如果确实存在效果，则发现效果的可能性），我们可以在研究结束时以每组 30 名参与者的数量来确定各种结果的中等效果（组间差异的大小）。向后推算，假设基线评估后有 20% 的人员流失，后续评估之间有 15% 的人员流失，我们需要大约 4,000 名基线参与者才能在 20 年后产生 1,680 名参与者。招聘阶段和初步审查大约需要3年时间才能完成。该研究已完成分两波（2000年10月至2001年12月和2003年2月至2003年11月）进行的试点阶段。该研究的流行病学阶段于 2004 年 8 月开始，目前正在进行现场彩排。全面的研究将于 2004 年 11 月 1 日在巴尔的摩的 Reservoir Hill 地区开始。 协变量——其他变量，如营养、环境和邻里影响、基因构成、家族史、活动水平、获得医疗保健的机会以及普遍的医疗、牙科、精神疾病、氧化应激和 DNA 修复能力，可能会调节 SES 和种族对心血管、肌肉骨骼、认知和自主功能的影响。例如： 该研究的营养领域将研究种族社会经济地位（SES）对营养状况的影响，并确定可能导致心脑血管健康和认知功能健康差异的营养因素。 该研究的生物标志物领域将检查健康差异和衰老可能的生物协变量。非裔美国人和社会经济地位低的人群中年龄相关疾病的早期出现和严重程度的增加表明，导致健康差异出现的因素也可能诱发“过早衰老”或“加速衰老”的表型。虽然我们并不认为健康差异是由与已知的遗传性早衰综合症相关的基因的遗传改变引起的。我们确实假设，在早发年龄相关疾病的低SES人群中，生物、社会心理、社会经济和环境因素的相互作用可能导致加速衰老的表型，在生物学上与这些综合征相似，具有增加的氧化应激易感性、氧化DNA损伤的过早积累、DNA修复缺陷和氧化应激生物标志物水平较高。因此，健康差异可能是高危人群中这种复杂相互作用的最终产物。 HANDLS 将通过测量氧化应激的生物标志物、评估研究最广泛的氧化 DNA 加合物的水平以及测量研究参与者的 DNA 修复能力来检验这一假设。在纵向研究中前瞻性测量氧化应激的生物标志物可以阐明氧化应激是否在衰老以及年龄相关疾病的发生和/或进展中发挥关键作用。它还可以提供对个体观察到的不同衰老轨迹的见解。