Measuring Health Effects of the Great Recession

描述（由申请人提供）：尽管长期以来有证据表明，从社会经济地位（SES）的最低水平到最高水平，健康状况越来越好，但SES-健康关系的因果性质尚未明确确立，并且这些关系的机制尚未得到很好的理解。从2008年开始，“大衰退”是一个重大的，在很大程度上是意料之外的，经济冲击，影响了绝大多数美国人，其对健康的影响有可能提供科学证据的因果关系的影响，社会经济地位对健康。假设经济衰退的时间和规模在很大程度上是意料之外的，大衰退可以被视为一种外源性的经济冲击，它提供了更多的机会来确定社会经济地位对健康的因果影响程度。该R21将根据经验评估是否可以使用经济衰退前后对相同的4，655人测量的独特丰富的纵向客观生物学数据（反映与主要发病率和死亡率相关的生理过程）来确定经济衰退的健康影响。这些来自多种族动脉粥样硬化研究（梅萨）的数据将与当地劳动力和住房市场的随时间变化的地区和年龄性别种族教育具体措施（住房市场有200多个邮政编码，劳动力市场至少有200个特定位置的人口统计学亚组）联系起来。在2008年秋季（经济衰退开始）之前收集了四波梅萨数据，并在2010年7月至2011年12月之间进行了第五次检查。与之前许多关于经济衰退对健康影响的工作中使用的自我报告健康数据相比，梅萨提供了对健康的主要生理标志物（包括收缩压、脉压、血糖、血脂、体重指数和腰臀比）进行标准化、客观评估的独特优势。将这些丰富的健康数据与大衰退之前和之后对同一个人测量的经济状况相结合，并与经济衰退的局部地区和人口统计学特定风险相结合，为评估经济压力对客观评估和重要健康指标的影响提供了无与伦比的机会。这项研究将描述这些健康指标如何随着时间的推移而变化，以及它们如何随着地区和人口统计学特定经济压力的变化而变化。该R21旨在提供初步证据，以建立大衰退对生物学（包括从储存的血液样本中测定的新生物标志物），行为（例如，运动、吸烟、酗酒），亚临床疾病（例如，颈动脉和外周动脉粥样硬化），显性疾病（例如，心血管事件、住院）和总死亡率。此外，广泛的梅萨遗传学数据也将允许在未来的工作中探索可能的基因与环境（衰退）的相互作用效应。

DESCRIPTION (provided by applicant): Despite long-standing evidence of strong gradients of increasingly better health from the lowest to the highest levels of socioeconomic status (SES), the causal nature of SES-health relationships has not been clearly established, and mechanisms underlying the relationships are not well understood. Beginning in 2008, the "Great Recession" was a major, and largely unanticipated, economic shock that impacted the vast majority of Americans and its impact on health has the potential to provide scientific evidence on the causal impact of SES on health. Assuming the timing and magnitude of the recession was largely unanticipated, the Great Recession can be treated as an exogenous economic shock that offers enhanced opportunities to establish the extent to which there are causal effects of SES on health. This R21 will empirically evaluate whether uniquely rich longitudinal, objective biological data (reflecting physiological processes linked to major morbidity and mortality) measured for the same 4,655 individuals before and after the Recession can be used to establish health effects of the Recession. These data from the Multi-Ethnic Study of Atherosclerosis (MESA) will be linked with time-varying area- and age-sex-race-education-specific measures of the local labor and housing markets (with over 200 zip-codes for housing markets and at least 200 location-specific demographic subgroups for labor markets). Four waves of MESA data were collected before Fall 2008 (onset of the Recession) with a 5th exam between July 2010 and December 2011. In contrast to the self-report health data used in much prior work on health effects of economic downturns, MESA offers the unique strength of standardized, objective assessments of major physiological markers of health, including systolic blood pressure, pulse pressure, blood glucose, serum lipids, body mass index and waist-hip ratio. Combining these rich health data with economic status measured on the same individuals before and after the onset of the Great Recession, and with local area- and demographic-specific exposures to the recession provides unparalleled opportunities to evaluate the effects of economic stress on objectively assessed and important health markers. The research will describe how these health markers change over time and how they change as exposure to area- and demographic-specific economic stress varies. This R21 is designed to provide initial evidence to establish feasibility and power for a larger, more comprehensive investigation (R01) of the impact of the Great Recession on biology (including new biomarkers assayed from stored blood samples), behaviors (e.g., exercise, smoking, heavy drinking), subclinical disease (e.g., carotid and peripheral atherosclerosis), overt disease (e.g., cardiovascular events, hospitalizations), and total mortality. Moreover, extensive MESA genetics data will also allow exploration of possible gene-by-environment (Recession) interaction effects in future work.