Health disparities and aging in societies in transition

描述（由研究者提供）：健康方面的社会差异是尚未解决的主要公共卫生问题；它们会影响人一生中的许多健康结果，包括老年人。我们可以利用共产主义垮台后该地区独特的社会和卫生条件，通过中欧和东欧（CEE）和前苏联（FSU）的研究来补充西方国家的研究，从而加强我们对老龄人口健康的社会差异的理解。中东欧/FSU中老年心血管疾病和其他慢性疾病的死亡率和发病率远高于西方，现有数据表明，与老年相关的其他结果（如残疾、身体功能下降和认知障碍）也是如此。将老龄人口健康方面的社会差异研究扩展到中东欧/FSU，将打破西方数据中存在的社会经济因素之间相互关联的混淆（因为中东欧/FSU中社会经济指标之间的关联较弱）；可以利用社会转型期间中东欧/前苏联社会条件和健康状况的巨大时间变化来解决内生性问题；并与西方研究，如美国健康与退休研究（HRS）和英国老龄化纵向研究（ELSA）进行比较。该申请的目的是建立在中东欧/FSU现有的心血管疾病研究的基础上，并通过重复测量健康、功能、社会地位、经济和社会心理因素，建立一项关于老龄化的纵向研究。本研究的具体目的是：(1)调查各国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)研究国家内部的社会差异，以确定对健康最重要的社会经济地位维度；(3)研究社会经济地位与健康之间的行为、社会心理和生物学机制；(4)健康状况不佳是否与老龄人口社会经济地位下降相关（内生性）。现有的研究是在俄罗斯、波兰和捷克共和国进行的，包括基线调查和死亡率随访。正在对45-69岁的男女随机抽样收集社会经济和社会心理因素、营养、酒精和生物样本方面的基线数据。建议进行新的数据收集浪潮（第二波），并增加立陶宛（作为波罗的海国家的一个例子）。研究工具将尽可能与HRS和ELSA中使用的相同，重点关注功能和残疾、认知、生活质量、社会经济地位、经济学和社会心理因素。这项新研究的预期总规模为2.8万名受试者。分析将检查横断面结果，基线和第二波之间健康和功能的变化，以及自基线以来心血管疾病的发病率和死亡率。

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.