Health Effects of Racial Segregation on Aging Adults

种族隔离对老年人健康的影响

• 批准号: 7498458
• 负责人: JOSEPH J SUDANO
• 金额: $ 19.57万
• 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/7498458
• 关键词: Address; Adult; African; African American; Age; Age-Years; Aging; Area; Cardiovascular Diseases; Censuses; Cessation of life; Characteristics; Chronic; Cities; Cohort Studies; Communities; Community Health; Community Health Systems; Condition; Consensus; County; Cross-Sectional Studies; Crowding; Data; Differential Mortality; Discrimination; Distal; Economics; Enrollment; Equation; Ethnic Origin; Ethnic group; Geographic Locations; Health; Health Policy; Health Status; Health behavior; Hispanics; Housing; Incidence; Individual; Infant; Intervention; Investigation; Knowledge; Label; Lead; Life; Link; Literature; Logistic Regressions; Longitudinal Studies; Measures; Mediating; Mediation; Mental Health; Methods; Minority Groups; Modeling; Neighborhoods; Not Hispanic or Latino; Outcome; Pathway interactions; Patient Self-Report; Physical Function; Policies; Poverty; Proxy; Purpose; Race; Range; Rate; Relative (related person); Research; Research Personnel; Resources; Retirement; Sampling; Schools; Series; Services; Shapes; Social Network; Socioeconomic Status; Specific qualifier value; Stratification; Structure; System; Testing; Time; To specify; Unemployment; United States; Work; base; design; ethnic minority population; experience; member; metropolitan; mortality; multilevel analysis; programs; prospective; racial and ethnic; segregation; social

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）：研究目的。健康状况取决于个人和社区两级的投入。种族居住隔离（RRS）是一个社区属性提出影响健康和健康状况。然而，其影响可能与社区及其居民的特点有关，并受其影响。RRS影响健康的程度及其发挥作用的途径尚未得到充分探讨。这项研究将：1）确定几个全球和地方RRS措施在解释社区和个人水平影响后的健康状况变化方面的独立影响; 2）使用社区和个人水平的中介因素，说明这些RRS措施影响健康变化的途径和机制;比较这些RRS指标的相对解释力，并确定这些指标之间的中介机制是否存在差异。研究方法：来自健康和退休研究的全国代表性数据，一项大型前瞻性队列研究，约4690名白色，1198名黑人和590名西班牙裔成年人，年龄在51至61岁之间，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，我们将制定可能位于RRS和健康状况之间的路径上的经济，社会，物理和卫生系统社区特征的操作措施。我们使用空间和空间测量，两组（黑人/白色或西班牙裔/白色）和多组（白色/黑人/西班牙裔）设计，在全局（即，大都市或城市）和地方或人口普查区级别。个人水平的SES，健康行为和慢性疾病的措施将包括在我们的模型。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年健康状况的重大下降、无变化或改善; 2）1992年至2002年健康状况的重大下降或死亡、无变化或改善; 3）使用包括死亡在内的自我报告的转换值的连续测量;和4）1992年至2000年之间a）机动性、B）敏捷性或c）设施的物理限制的变化。在控制社区和个人水平特征后，将使用种族/种族分层分层/多层次模型和逻辑回归评估RRS与健康状况之间的关联。将使用人种/种族分层结构方程模型来描述RRS、社区和个人水平特征与健康状况之间的中介途径。意义：目前的提案是第一个使用纵向数据来探索RRS和健康之间潜在因果关系的研究之一。了解这些途径中的调解和适度将促进我们目前对社区一级因素对健康的重要性的理解，并将重新将政策决定的重点放在解决健康状况差异的根本原因的干预措施上。