Personality-Epidemiologic Research on Inequalities in Longevity

描述（由申请人提供）：了解长寿方面的社会不平等如何以及为何存在是一个主要的公共卫生优先事项，需要进行综合理论测试以得出结论 转化为有用的临床工具。该应用程序直接来自新的早期研究员 Ben Chapman 的 K08 研究计划，响应 NIA 优先事项（PA-11-124、RFA-AG-11-004、PA-09-216、NIA 人格与健康老龄化工作组）以及医学研究所（基因、行为和社会环境委员会报告）和 Cochrane 诊断小组（声明）发出的行动呼吁改善预后模型的 10 个步骤）。我们组建了一个由 18 项研究组成的联盟，涵盖约 11,000 名中年和老年人，称为“危险项目”（长寿不平等的人格流行病学研究）。研究将得到协调并与国家死亡指数 (NDI) 联系起来，提供平均 (SD) = 12(4) 年期间的后续数据。在目标 1 中，我们将使用 PERIL 项目数据来检验根据长寿的社会结构和人格 (SSP) 模型得出的假设。 SSP 模型提出，社会结构的贡献与大 5 人格表型所捕获的个人社会情感和行为倾向是交织在一起的。在应对社会经济劣势方面发挥适应性作用的性格倾向也可能损害一生的健康，导致早期死亡。因此，长寿的社会和个性决定因素可能以未知的程度耦合。了解这种社会结构-心理界面可以为旨在减少社会不平等的公共卫生计划和政策提供信息。在目标 2 中，我们检验了累积劣势的假设，该假设表明，人格-SES 死亡风险不仅随着年龄的增长而增加，而且与年龄的关联性越来越强。此外，还研究了这些风险的潜在机制。目标 3 利用目标 1 和 2 的发现来开发临床预后模型——有效、务实且可操作的死亡风险预测模型。随着个性化医疗的出现，预后模型越来越受欢迎，并根据个人的特定风险因素概况对健康结果进行个性化、数据驱动的风险估计。迄今为止，尽管 SES 和性格具有精算预测能力，但预后模型已严格纳入生物医学风险因素。因此，目标 3 的重点是“使人接受个性化医疗”，通过使用 SES 和人格表型的数据开发改进的 10 年死亡风险预后模型，无论是单独使用还是与查尔森合并症指数（一种流行的死亡率预后模型）的标准慢性病成分结合使用。综合数据分析 (IDA) 将用于通过多级结构方程模型（目标 1 和 2）和参数生存模型（目标 3）来利用数据联盟的力量和广度。 PERIL 项目团队包括社会流行病学、人格与长寿、IDA、NDI 联系、预后模型开发以及一般医疗实践中预后模型使用方面的专家。 PERIL 项目为未来在一般医疗实践中基于社会环境和个性的新预后模型的实施试验奠定了基础。最后，PERIL 项目为美国未来的长寿研究提供了基础设施。

DESCRIPTION (provided by applicant): Understanding how and why social inequalities in longevity exist is a major public health priority, requiring integrative theory testing with a view toward translation into useful clinical tools. This application emerges directly from New and Early Stage Investigator Ben Chapman's K08 research program, and is responsive to NIA priorities (PA-11-124, RFA-AG-11-004, PA-09-216, NIA Workgroup on Personality and Healthy Aging) and to calls for action issued by the Institute of Medicine (Committee Report on Genes, Behavior, and the Social Environment) and Cochrane Diagnosis Group (Statement on 10 Steps to Improving Prognostic Models). We have assembled a consortium of 18 studies spanning roughly 11,000 midlife and older adults, called Project Peril (Personality Epidemiologic Research on Inequalities in Longevity). Studies will be harmonized and linked to the National Death Index (NDI), providing follow- up data over a Mean(SD) = 12(4) year period. In Aim 1, we will use Project PERIL data to test hypotheses derived from the Social Structure and Personality (SSP) model of longevity. The SSP model proposes that the social structure contributes and individual socio-emotional and behavioral dispositions captured by Big 5 personality phenotype are interwoven. Dispositional tendencies that play an adaptive role in negotiating socioeconomic disadvantage may also compromise health over the lifespan, leading to earlier mortality. Thus, social and personality determinants of longevity may be coupled to an unknown degree. Understanding this sociostructural-psychological interface can inform public health programs and policy aimed at reducing social inequalities. In Aim 2, we test the hypothesis of cumulative disadvantage, which suggests that personality-SES mortality risk not only increase with age, but become increasingly coupled with age. As well, potential mechanisms of these risks are studied. Aim 3 leverages Aim 1 and 2 findings to develop clinical prognostic models--valid, pragmatic, and actionable prediction models of mortality risk. Prognostic models have grown in popularity with the advent of personalized medicine, and yield individualized, data- driven risk estimates for health outcomes based on a person's specific risk factor profile. Thus far, prognostic models have incorporated strictly biomedical risk factors, despite the actuarial predictive power of SES and personality. Aim 3 therefore focuses on "putting the person in personalized medicine" by developing improved prognostic models for 10-year mortality risk using data on SES and personality phenotype, both alone and in conjunction with standard chronic disease components of the Charlson Comorbidity Index, a popular prognostic model for mortality. Integrative Data Analysis (IDA) will be used to harness the data consortium's power and breadth, via multilevel structural equation models (Aims 1 and 2) and parametric survival models (Aim 3). The Project PERIL team includes experts in social epidemiology, personality and longevity, IDA, NDI linkage, prognostic models development, and prognostic model use in general medical practice. Project PERIL lays the foundation for a future implementation trial of new prognostic models informed by social circumstances and personality in general medical practice. Finally, Project PERIL provides an infrastructure for future US longevity research.