Longterm Impact of Natural Disasters on Disability and Health in Older Americans

描述(申请人提供)：随着社会老龄化和家庭结构调整，了解个人如何成为残疾人变得越来越重要。新的残疾与死亡率增加、医疗费用大幅增加(通常由公共支付者承担)以及家庭和照顾者的沉重负担有关。虽然按照Verburgge和Jette及其继任者的理论，残疾过程传统上被视为慢性和渐进的，但越来越多的人认识到，急性事件在残疾中发挥着关键作用。医疗疾病并不是唯一可能导致残疾的事件。NIA&NINR最近发布了PA-11-265号文件，呼吁“对灾难中的老年人进行社会和行为研究”，承认自然灾害很常见，但我们对其对健康和残疾的影响知之甚少。国家研究理事会的人口委员会在2009年发布了一份报告，不仅记录了我们在这一领域的无知，而且重要的是，研究灾害以了解残疾和健康的基本过程的潜在价值。我们的长期研究议程是：(A)检验现有卫生和福利计划没有充分解决的假设，即自然灾害会给幸存者造成持久的发病率，以及(B)发现产生持久发病率的可补救机制。在这里，我们建议在全国范围内测试生活在灾区与个人的长期残疾和医疗保健使用之间的联系。为了执行这项测试，我们将结合链接的健康和退休研究(HRS)/联邦医疗保险文件中16,000多名受访者的独特纵向资源，以及新构建的1998至2012年间联邦应急管理局所有灾难声明的映射。我们将通过这些具体目标，以跨时间和跨空间的概括性视角，解决现有单一灾害详细研究文献中的主要空白：目标1：量化灾害特征--以灾害类型、公共基础设施的修复费用和恢复持续时间衡量--与灾后5年幸存者伤残水平上升之间的联系。目标2：量化灾难特征与幸存者住院可能性增加之间的联系。目标3：检验残疾水平和住院可能性增加的假设 灾难发生后，对于那些生活在贫困程度较高的县的人来说，情况更糟。本提案特别针对PA-11-265。这一建议是创新的，因为在以前的研究中，灾难的长期影响，特别是对脆弱的美国老年人的影响，被系统性地忽视了。它意义重大，因为它将解决相对常见但未得到充分研究的暴露对公共卫生的影响。此外，R21的一个关键贡献将是评估国家研究委员会猜想的可行性，即自然灾害可以被研究为对环境的外生冲击，从而我们可以测试和阐述残疾发展中通常是内生的机制。

DESCRIPTION (provided by applicant): With the aging of society and restructuring of families, it is increasingly important to understand how individuals become disabled. New disability is associated with increased mortality, substantial increases in medical costs (often borne by public payers), and a heavy burden on families and caregivers. While the disablement process-as theorized by Verburgge & Jette and their successors-has traditionally been seen as chronic and gradual, there is increasing recognition that acute events play a critical role in disability. Medical illnesses are not the only potentially disabling events. NIA & NINR recently posted PA-11-265, calling for "Social and Behavioral Research on the Elderly in Disasters" in recognition that natural disasters are common, but we know little about their impact on health and disability. The National Research Council's Committee on Population published a report in 2009 documenting not only our ignorance in this area, but, importantly, the potential value of studying disasters to understand fundamental processes in disability and health. Our long-term research agenda is (a) to test the hypothesis that natural disasters cause enduring morbidity for survivors that is not fully addressed by existing health and welfare programs, and (b) to discover remediable mechanisms that generate that enduring morbidity. Here we propose a nationwide test of the association of living in a disaster area with individuals' long-term disability and heath care use. To perform this test, we will combine the unique longitudinal resources of over 16,000 respondents in the linked Health and Retirement Study (HRS) / Medicare files with a newly constructed mapping of all FEMA disaster declarations between 1998 and 2012. We will address key gaps in the existing literature of detailed single- disaster studies with a generalizable perspective across time and space via these Specific Aims: AIM 1: Quantify the association between the characteristics of a disaster-measured as the type of disaster, the repair cost to public infrastructure, and duration of recovery-and increases in level of disabilit among survivors, for 5 years post- disaster. AIM 2: Quantify the association between the characteristics of a disaster and increases in the likelihood of hospitalization among survivors. AIM 3: Test the hypothesis that increases in level of disability and likelihood of hospitalization after disasters are worse for those living in counties with higher levels of poverty. This proposa is specifically responsive to PA-11-265. This proposal is innovative because long-term effects of disasters, particularly for vulnerable older Americans, have been systematically neglected in previous research. It is significant because it will address the public health consequences of a relatively common but understudied exposure. Further, a key contribution of this R21 will be to evaluate the feasibility of the National Research Council conjecture that natural disasters can be studied as exogenous shocks to the environment, and that we can thereby test and elaborate usually endogenous mechanisms in the development of disability.