Health Differences at Older Ages between U.S. and England - Role of Local Contextual Factors

项目摘要 美国在医疗保健方面的支出远远超过其他高收入国家。然而，老年人 与许多其他高收入国家的老年人相比，美国人的病情更重，寿命更短。 甚至一些中等收入国家。美国健康状况处于劣势的原因是 没有很好地理解。美国老年人与高收入人群之间的健康差距 即使在控制了教育和行为等个人层面的因素后， 风险老年人更有可能依赖当地的物质和社会环境， 地区与此同时，地方一级的背景特征在不同国家和地区之间有很大差异。 可能导致各国健康/死亡率差异的国家。 然而，尚未系统地审查当地的设施和资源， 了解各国老年人健康状况的差异。 该项目将评估当地的背景特征是否，如果是， 解释了美国老年人的健康状况比英国差。使用 健康与退休研究（HRS）和英国老龄化纵向研究（艾尔莎）， - 基于链接到HRS的新可用上下文数据集，我们将创建一个 可比较的上下文数据集被链接到每个地理边界处的艾尔莎。我们将 使用HRS和艾尔莎之间可比较的当地地理区域， 美国的人口普查跟踪和英国的地方当局和中间层超级输出区。 - 我们将评估当地环境措施在多大程度上解释了关键的健康和死亡率 美国和英国之间的差异。健康成果包括全面的 自我报告的健康测量，测量的身体表现（例如，步态速度）和认知 功能和生物标志物（例如，HRS和艾尔莎之间具有可比性的HbA 1c）。 - 我们将评估美国和美国之间收入和财富梯度在健康/死亡率方面的差异。 和英国，并评估在何种程度上当地的背景因素影响的差异。 拟议的探索性和发展性项目将有助于推进以下方面的文献： 新的方向，通过提供新的见解，潜在的机制， 特征影响国际健康差距。该项目的成果将包括： 与HRS和艾尔莎相关的背景数据集;关于局部区域潜在作用的发现 国际健康差距的环境;以及国际研究合作， 将大大有利于我们未来的研究，并可能最终扩大健康研究 在HRS和艾尔莎以外的老年人中存在差异。 1

Project Summary The U.S. spends far more on health care than other high-income countries. Yet, older adults in the U.S. are sicker and have shorter lives compared to older adults in many other high-income countries and even some middle-income countries. Reasons for the U.S. health disadvantage are not well understood. Substantial health gap between the U.S. older adults and their high income peers persists even after controlling for individual-level factors such as education and behavioral risks. Older adults are more likely to rely on the physical and social environment in their local areas. At the same time, local area-level contextual characteristics vary substantially across countries which might have contributed to differences in health/mortality across countries. However, local amenities and resources have not been examined systematically in efforts to understand difference in older adults' health status across countries. This project will assess whether and, if so, the extent to which local, contextual characteristics explain the poorer health status of older adults in the U.S. compared to England. Using the Health and Retirement Study (HRS) and English Longitudinal Study of Aging (ELSA), - Based on a newly available contextual dataset that is linked to the HRS, we will create a comparable contextual dataset to be linked to the ELSA at each geographic boundary. We will use comparable, local geographic areas between HRS and ELSA by examining county and census track for the U.S. and local authority and middle layer super output area for England. - We will assess the extent to which local contextual measures explain key health and mortality differences between the U.S. and the England. Health outcomes include both comprehensive self-reported health measures, measured physical performances (e.g., gait speed) and cognitive functioning, and biomarkers (e.g., HbA1c) that are comparable between HRS and ELSA. - We will assess differences in income and wealth gradient in health/mortality between the U.S. and England, and assess the extent to which local contextual factors influence the difference. The proposed exploratory and developmental project will contribute to advancing literature in the new directions by providing new insights into potential mechanism whereby local contextual characteristics influence the international health gap. Outcomes from this project will include: contextual datasets linked to the HRS and ELSA; findings on the potential role of local-area environment for the international health gap; and an international research collaboration that will substantially benefit our future study and may ultimately expand research on health differences at older ages beyond HRS and ELSA. 1