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: 8931549
• 负责人: michele k evans
• 金额: $ 353.64万
• 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/8931549
• 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; Government; 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; endothelial dysfunction; executive function; 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 and was completed in June 2013 with a show rate of 91%. The Wave 3 protocol in keeping with the longitudinal study design maintained 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 began September 27 of 2013 and was immediately hampered by the government shut down. 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 as well as a measure of endothelial dysfunction. 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 have become home-bound over the course of the study will begin in late 2014.

HANDLS研究是一项前瞻性、流行病学、跨学科、纵向研究，研究对象为30-64岁的非裔美国人和白人基线代表性样本，通过家庭筛查从巴尔的摩市12个人口普查区的区域概率样本中招募的固定参与者队列。HANDLS设计是基于2000年人口普查的巴尔的摩区域概率样本。使用这种方法，与调查统计学家合作，我们选择了12个社区，以满足种族的SES的年龄分布的前瞻性队列，因为他们可能会产生代表性的分布巴尔的摩市有足够的个人，以填补抽样设计的基础。 在12个社区内，住房单元被选择为已知的非零选择机会。 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这些人纳入样本。 从这些概率中，我们可以计算权重来调整不相等的选择概率。 需要这些权重来计算将任何年龄-性别-种族-贫困组的联合收割机受试者组合在一起的估计值。根据2004年《卫生和公众服务贫困准则》的125%，贫困状况指数为125%。 最初的考试和征聘阶段花了大约4年时间完成。研究数据分两部分收集。第一部分是家庭访谈，包括问卷调查参与者的健康状况，卫生服务利用，心理社会因素，营养，邻里特征和人口统计学。第二部分在医学研究车辆上收集，包括病史和体格检查、饮食回忆、认知评价、心理生理学评估，包括心率变异性、动脉厚度、颈动脉超声检查、肌力和骨密度评估以及实验室测量（血液化学、血液学、氧化应激生物标志物和遗传研究生物材料）。 使用我们的移动的医学研究车辆，我们访问每个人口普查区4个月，我们将重新访问每个人口普查区在3.5年的周期。 HANDLS于2009年3月30日完成了其基线检查波，最终总计招募了3720名参与者。 该队列由非裔美国人（59%）和白人（41%）组成。 大约41%的同龄人报告家庭收入低于125%的贫困状况。 在125%贫困线以下的人中，13%是白色人，28%是非洲裔美国人。 在125%以上的贫困人口中，28%是白色人，31%是非洲裔美国人。 基线时样本的平均年龄为47.7岁。 没有与性别或种族相关的显著年龄差异。 低于125%贫困线的参与者比高于125%贫困线的参与者略年轻。 HANDLS体检率为75.2%，与国家健康和营养检查研究（NHANES）的75%体检率相当。第三波考试于2009年7月开始，2013年6月完成，显示率为91%。 与纵向研究设计一致的第3波方案保持了许多与基线第1波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、健康服务、基因组学（遗传学和表观遗传学）和疾病的分子生物标志物。 该方案还包括新的研究领域，特别关注关键的健康差异，包括肾功能，神经解剖学，财务和健康知识。这些项目涵盖了广泛的临床医学领域，包括大量已建立的少数民族调查人员以及学生和医生的培训。 第四波将于2013年9月27日开始，并立即受到政府关闭的阻碍。 新方案的亮点包括增强的心血管领域，增加了踝臂指数，颈动脉内膜厚度和脉搏波速度的纵向评估以及内皮功能障碍的测量。 身体活动评估也将通过增加加速度计来加强，认知领域将使用较少依赖识字的措施来评估执行功能。 为防止因研究期间居家受试者的数据缺失而导致的偏倚而制定的家访方案将于2014年底开始。