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是如何以及为什么存在的，是一个主要的公共卫生优先事项，需要综合理论测试， 转化为有用的临床工具。该应用程序直接来自新的和早期阶段的研究员本查普曼的K 08研究计划，并响应NIA的优先事项（PA-11-124，RFA-AG-11-004，PA-09-216，NIA人格和健康老龄化工作组）以及医学研究所发布的行动呼吁（基因、行为和社会环境委员会报告）和科克伦诊断小组（关于改善预后模型的10个步骤的声明）。我们已经组建了一个由18项研究组成的联盟，涵盖了大约11，000名中年和老年人，称为Project Peril（长寿不平等的人格流行病学研究）。研究将与国家死亡指数（NDI）相协调，并提供平均（SD）= 12（4）年期间的随访数据。在目标1中，我们将使用Project PERIL数据来检验来自社会结构和人格（SSP）长寿模型的假设。SSP模型提出，社会结构做出了贡献，并且大五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。在协商社会经济劣势方面发挥适应作用的性格倾向也可能损害一生的健康，导致过早死亡。因此，长寿的社会和性格决定因素可能在某种程度上是相互关联的。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，这表明个性-SES死亡风险不仅随着年龄的增长而增加，而且随着年龄的增长而增加。并对这些风险的潜在机制进行了研究。目标3利用目标1和2的发现来开发临床预后模型-有效，实用和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，并且基于个人的特定风险因素概况产生针对健康结果的个性化、数据驱动的风险估计。到目前为止，预后模型已纳入严格的生物医学风险因素，尽管社会经济地位和个性的精算预测能力。因此，目标3的重点是“将人置于个性化医疗中”，通过使用SES和个性表型数据开发10年死亡率风险的改进预后模型，单独使用和结合Charlson Comorbid指数的标准慢性疾病组成部分，这是一种流行的死亡率预后模型。综合数据分析（IDA）将用于通过多层次结构方程模型（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。项目危险团队包括社会流行病学、人格和寿命、IDA、NDI联系、预后模型开发和预后模型在一般医疗实践中的使用方面的专家。PERIL项目为未来在全科医疗实践中实施基于社会环境和个性的新预后模型的试验奠定了基础。最后，Project PERIL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.