Healthy Aging In Neighborhoods of Diversity Across the Life Span (HANDLS)

一生中多元化社区的健康老龄化 (HANDLS)

• 批准号: 8736570
• 负责人: michele k evans
• 金额: $ 281.26万
• 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/8736570
• 关键词: Address; African American; Age; Age Distribution; Age-Years; American; Ankle; Area; Automobile Driving; Baltimore; Behavioral; Binding; Biocompatible Materials; Biological Factors; Biological Markers; Blood Chemical Analysis; Body Composition; Bone Density; Cardiovascular Diseases; Cardiovascular system; Censuses; Characteristics; Cities; Clinical Medicine; Clinical Research; Cognition; Cognitive; Communities; Complex; Data; Development; Diet; Disease; Environment; Environmental Risk Factor; Epidemiologic Studies; Epidemiology; Epigenetic Process; Evaluation; Failure; Gender; Genetic; Genomics; Guidelines; Health; Health Services; Health Status; Hematology; Home environment; Home visitation; House Call; Household; Housing; Human; Impaired cognition; Incidence; Income; Individual; Interview; Laboratories; Literature; Longevity; Longitudinal Studies; Measurement; Measures; Medical History; Medical Research; Methodology; Methods; Minority; Molecular; Morbidity - disease rate; Neighborhoods; Neuroanatomy; Occupations; Outcome; Oxidative Stress; Participant; Pathway interactions; Performance; Phase; Physical Examination; Physical Function; Physical activity; Physicians; Physiologic pulse; Poverty; Probability; Probability Samples; Protocols documentation; Proxy; Psychology; Psychophysiology; Psychosocial Factor; Questionnaires; Race; Recording of previous events; Recruitment Activity; Renal function; Reporting; Research; Research Design; Research Personnel; Risk; Risk Factors; Role; Sample Size; Sampling; Services; Site; Societies; Socioeconomic Status; Students; Surveys; Thick; Time; Training; Translational Research; Ultrasonography; Visit; Weight; Work; age difference; age related; base; bone quality; cohesion; cohort; demographics; design; executive function; falls; follow-up; health care quality; health care service utilization; health disparity; health literacy; healthy aging; heart rate variability; improved; indexing; literacy; low socioeconomic status; medical examination; meetings; mortality; multidisciplinary; muscle strength; novel; nutrition; pre-clinical; prevent; prospective; psychosocial; racism; sex; social; social capital; socioeconomics; tool

The HANDLS study is a prospective, epidemiologic, interdisciplinary, longitudinal study of a baseline representative sample of African Americans and whites between 30-64 years of age recruited as a fixed cohort of participants by household screenings from an area probability sample of twelve census segments in Baltimore City. The HANDLS design is an area probability sample of Baltimore based on the 2000 Census. Using this methodology, working with survey statisticians we chose 12 neighborhoods to meet race by SES by age distribution of the prospective cohort because they were likely to yield representative distributions of Baltimore City with sufficient individuals to fill the sampling design based. Within the 12 neighborhoods, housing units were selected with a known non-zero chance of selection. The addresses were screened for individuals who meet the age-gender-race-poverty sample size, and those were chosen to be included in the sample using a probability sampling method. From these probabilities, we can compute weights to adjust for unequal probabilities of selection. These weights will be needed to compute estimates that combine subjects across any of the age-gender-race-poverty group. The poverty status delimiter is 125% poverty based on 125% of the 2004 Health and Human Services Poverty Guidelines. The initial examination and recruitment phase took approximately 4 years to complete. The study data was collected in two parts. The first part consisted of an in-home interview that included questionnaires about the participants health status, health service utilization, psychosocial factors, nutrition, neighborhood characteristics, and demographics. The second part was collected on the medical research vehicles and included 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). Using our mobile medical research vehicles, we visit each census tract for 4 months and we will re-visit every census tract in a 3.5-year cycle. HANDLS completed its baseline examination wave on March 30, 2009 with a final total accrual of 3720 participants. The cohort is comprised of African American (59%) and Whites (41%). Approximately 41% of the cohort reported a household income below the 125% poverty status delimiter. Of those below the 125% poverty delimiter, 13% were white and 28% African American. Of those above the 125% poverty delimiter, 28% were white and 31% African American. The mean age of the sample was 47.7 years at baseline. There were no significant age differences associated with sex or race. Participants below the 125% poverty delimiter were slightly younger than those above the delimiter. HANDLS medical examination rate was 75.2% comparable to the 75% examination rate for the National Health and Nutrition Examination Study (NHANES). Wave 3 examinations started in July 2009. At this time, Wave 3, has been completed revisits with a show rate of 91%. The Wave 3 protocol in keeping with the longitudinal study design maintains many of the same study domains as the baseline wave 1 examination including: cognition, cardiovascular disease, nutrition, physical performance, psychology, health services, genomics (genetics and epigenetics), and molecular biomarkers of disease. This protocol also included new areas of study particularly focused on critical health disparities including, renal function, neuroanatomy, financial and health literacy. These are projects that span a broad range of areas of clinical medicine and include a large number of established minority investigators as well as students and physicians in training. Wave 4 will begin in the early fall of 2013. The new protocol highlights include an enhanced cardiovascular domain with the addition of the Ankle-Brachial Index, longitudinal assessment of carotid intimal thickness and pulse wave velocity. Physical activity assessment will also be enhanced by addition of accelerometry and the cognitive domain will use measures that are less dependent on literacy to assess executive function. The Home Visit Protocol developed to prevent the bias resulting from missing data from participants who become home-bound over the course of the study will begin in late 2013.

HANDLS研究是一项前瞻性、流行病学、跨学科、纵向研究，从巴尔的摩市12个人口普查区段的区域概率样本中，通过家庭筛查招募30-岁之间的非裔美国人和白人作为固定队列参与者的基线代表性样本。HANDLS设计是巴尔的摩基于2000年人口普查的面积概率样本。使用这种方法，与调查统计学家合作，我们选择了12个社区，按照潜在队列的年龄分布满足SES的种族要求，因为它们可能产生巴尔的摩市的代表性分布，具有足够的个人来满足基于抽样设计的基础。在这12个社区中，住房单元的选择机会已知不为零。这些地址被筛选出符合年龄-性别-种族-贫困样本量的个人，并使用概率抽样方法选择那些被包括在样本中。根据这些概率，我们可以计算权重，以调整不相等的选择概率。这些权重将被用来计算结合任何年龄、性别、种族和贫困群体的受试者的估计。根据2004年《卫生和公共服务贫困准则》的125%，贫困状况的分界线是125%的贫困。 最初的考试和征聘阶段花了大约4年时间才完成。研究数据分两部分收集。第一部分由家庭访谈组成，包括关于参与者健康状况、卫生服务利用、心理社会因素、营养、社区特征和人口统计学的问卷调查。第二部分是在医学研究工具上收集的，包括病史和体检、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、肌肉力量和骨密度评估，以及实验室测量(血液化学、血液学、氧化应激生物标记物和用于基因研究的生物材料)。使用我们的移动医疗研究车辆，我们将在4个月内访问每个人口普查区域，并将在3.5年的周期中重新访问每个人口普查区域。 HANDLS于2009年3月30日完成了基准考试波，最终总应计人数为3720人。这一群体由非裔美国人(59%)和白人(41%)组成。约有41%的人报告家庭收入低于125%的贫困状况分界线。在125%的贫困线以下的人中，13%是白人，28%是非裔美国人。在125%的贫困线以上的人中，28%是白人，31%是非裔美国人。样本的平均年龄在基线时为47.7岁。性别或种族方面没有显著的年龄差异。低于125%贫困分界线的参与者比超过125%贫困分界线的参与者略年轻。HANDLS体检率为75.2%，与国家健康与营养检查研究(NHANES)75%的体检率相当。第三波考试于2009年7月开始。此时，《浪潮3》已经以91%的播放率完成了复访。 符合纵向研究设计的第3波方案保持了许多与第1波基线检查相同的研究领域，包括：认知、心血管疾病、营养、体能、心理学、卫生服务、基因组学(遗传学和表观遗传学)和疾病的分子生物标志物。该议定书还包括新的研究领域，特别侧重于严重的健康差距，包括肾功能、神经解剖学、金融和健康知识。这些项目涉及临床医学的广泛领域，包括大量成熟的少数民族调查人员以及正在接受培训的学生和医生。第四波将于2013年初秋开始。新协议的亮点包括增强的心血管领域，增加了踝臂指数，纵向评估颈动脉内膜厚度和脉搏波速度。体力活动评估也将通过增加加速度计得到加强，认知领域将使用较少依赖识字的措施来评估执行功能。为防止因研究过程中被困在家中的参与者丢失数据而造成的偏见而制定的回访议定书将于2013年底开始实施。