Understanding Social Disparities in Health and Aging

描述（由申请人提供）：本竞争性更新提案中描述的研究旨在通过五个目标来维持和加强美国人改变生活（ACL）研究，该研究始于1986年，是目前最古老的全国性代表性前瞻性研究，广泛研究健康的社会经济和社会心理决定因素，以及健康和健康差异如何在整个生命过程中发挥作用。这是一个独特的研究项目和主要的公共使用数据集，用于分析和理解健康随年龄变化的社会差异，特别是在整个成年生命过程中死亡率、发病率、功能限制和残疾的推迟或压缩。ACL的研究关注并促进了美国公共卫生服务的健康人2010战略计划的两个首要目标：1)增加健康的积极预期寿命；2)减少健康方面的社会差距。该提案的五个具体目标是：1)通过开展第五波数据收集和使用国家死亡指数、死亡证明核查和其他死亡率跟踪程序继续确定年度死亡率，至少到2013年，扩大对1986年ACL样本中幸存成员的纵向随访；2)为ACL开发一个方法/生物统计核心，这将a)为项目提供专业知识，以便对健康长期变化和轨迹的决定因素进行日益复杂的分析，b)开发和应用创新的统计/方法研究，以改进纵向分析并调整分析中的选择和损耗，从而提高我们和他人利用ACL和类似纵向数据的能力；3)了解发病率和死亡率的社会差异背后的机制，并对其进行压缩；4)在ACL第5波中增加关于医疗、残疾和损伤的新措施，以扩大所研究的健康状况结果，并调查选定的生物医学干预措施在维持、增强或减轻不同健康结果随年龄变化的社会差异方面的作用；5)利用现有的工作条件和过渡措施，并在ACL5中增加新的措施，以便在当前美国和世界经济危机的背景下，调查有酬工作、无酬生产活动和“退休”的变化模式和顺序。

DESCRIPTION (provided by applicant): The research described in this competing renewal proposal seeks through five aims to maintain and enhance the Americans' Changing Lives (ACL) study, which was started in 1986, and is the oldest on-going nationally- representative prospective study of a broad range of socioeconomic and psychosocial determinants of health, and of how health and health disparities play out over the full life course. It is a unique research project and major public use data set for analyzing and understanding social disparities in the way health changes with age, especially the postponement or compression of mortality, morbidity, functional limitations, and disability over the entire adult life course. The ACL study focuses on and contributes to the two overarching goals of the U.S. Public Health Service's Healthy People 2010 strategic plan: 1) increasing healthy active life expectancy and 2) reducing social disparities in health. The five specific aims of this proposal are: 1) to extend the longitudinal follow-up of surviving members of the 1986 ACL sample by conducting a fifth wave of data collection and continuing annual mortality ascertainment using the National Death Index, death certificate verification, and other mortality tracking processes through at least 2013; 2) to develop a methodological/biostatistical core for ACL which will a) provide expertise to the project for increasingly complex analyses of the determinants of long term changes and trajectories in health, and b) develop and apply innovative statistical/methodological research to improve longitudinal analysis and adjust for selection and attrition in analyses, thus, improving our and others' ability to utilize ACL and similar longitudinal data; 3) to understand mechanisms underlying social disparities in morbidity and mortality and the compression thereof; 4) to add new measures regarding medical care, disability and impairment to ACL Wave 5 so as to expand the health status outcomes under study and investigate the role of selected biomedical interventions in maintaining, enhancing or alleviating social disparities in the way different health outcomes change with age; and 5) to capitalize on existing measures of work conditions and transitions and add new ones to ACL5 in order to investigate changing patterns and sequencing of paid work, unpaid productive activities, and "retirement", in the context of current crises of the American and world economies.