Physical Frailty in Urban African-Americans

描述（由申请人提供）：“城市非洲裔美国人身体虚弱”的修订竞争性更新要求五年的资金（11-15年级），以便对居住在圣路易斯的社区居住的非洲裔美国人的代表性队列进行额外的数据收集和分析，称为非洲裔美国人健康（AAH）项目。在2000-2001年的基线评估中，998名入选的AAH受试者年龄在49至65岁之间，其中463名来自非常贫困的内城地区，535名来自较富裕的郊区；865人还活着，并继续参与。一个经验丰富的团队已经收集了五次高质量的年度参与和数据，为该领域做出了宝贵的贡献。在后续研究中，我们建议在基线后7年和8年进行电话访谈（分别持续50分钟和25分钟），并在基线后9年进行详细的家庭评估（120分钟）。我们通过添加一个全面的，创新的方法来检查上下文效应，广泛的弹性调查和前沿的分析方法来扩展先前的研究主题。我们将利用十年来的八波数据，实现两个具体目标：(1)使用个人水平的数据调查该队列的残疾过程；(2)调查不利的社区条件对残疾过程的独立影响。我们假设失能过程可以被看作是一个有序的过程，其中25项任务的主要转变是从高功能（HF）到亚临床状态（SC；定义为没有报告的困难，但执行方法或频率发生变化），从SC到困难(D)，再从D到不良健康结果（例如跌倒、死亡）。主要的分析方法包括：(a)单个任务的多状态转换模型和(b)三种心理测量sound复合测量方法的固定和随机截距和系数混合效应模型，分别和同时检查复合HF， SC和D计数轨迹。对于目标2，我们的主要假设是：(a)在调整了个人层面的因素后，不利的社区条件（建筑环境不利于身体活动，服务的可获得性较低，区域层面的剥夺增加）与残疾结果相关；(b)服务供应的负面影响在不同的空间尺度上与建筑环境和匮乏的负面影响不同；(c)不利的社区条件可用于针对未来的干预措施，以改善残疾结果。这两项研究的目的都是研究康复和恶化，以及假设的风险因素（如肥胖）和保护性因素（如教育）对残疾结果的影响。分析涉及多层次和新颖的地质统计技术。我们对所有提出的评估和分析方法都有经验，这些方法有足够（bbb80 %）的能力来检测所有假设的小到中等影响。多项次要研究（例如，对坠落的恐惧，生活空间流动性）也将继续进行。

DESCRIPTION (provided by applicant): This revised competitive renewal of "Physical Frailty in Urban African Americans" requests five years of funding (Y11-15) to enable additional data collection on and analysis of a representative cohort of community-dwelling African Americans living in St. Louis, known as the African American Health (AAH) project. The 998 enrolled AAH subjects were 49 to 65 years of age at baseline evaluation in 2000-2001, 463 from a very poor inner-city area and 535 from more affluent suburban conditions; 865 are alive and continue to participate. Five annual waves of high quality participation and data have already been collected by an experienced team that has made valuable contributions to the field. In the continuation, we propose to obtain telephone interviews (lasting 50 and 25 minutes, respectively) seven and eight years after baseline and a detailed in-home evaluation (120 minutes) nine years after baseline. We expand prior research themes by adding a comprehensive, innovative approach to examining contextual effects, extensive investigations of resilience, and cutting-edge analytic methods. With the combined eight waves of data over ten years, we will pursue two specific aims: (1) investigate the process of disablement in this cohort using individual-level data and (2) investigate the independent effect of adverse neighborhood conditions on the disablement process. We hypothesize that the disablement process can be viewed as an ordered progression in which the principal transitions for 25 tasks are from high functioning (HF), to subclinical status (SC; defined as no reported difficulty but change in either method or frequency of performance), from SC to difficulty (D), and from D to adverse health outcomes (e.g., falls, death). Primary analytic methods involve (a) multi-state transition models for individual tasks and (b) mixed effect models with both fixed and random intercepts and coefficients for three psychometrically-sound composite measures, examining the composite HF, SC, and D count trajectories both individually and simultaneously. For aim 2, our primary hypotheses are: (a) adverse neighborhood conditions (built environment less conducive to physical activity, lower availability of services, and increased area-level deprivation) are associated with disability outcomes, after adjusting for individual- level factors; (b) the negative effect of service availability operates at a different spatial scale than those of the built environment and deprivation; and, (c) adverse neighborhood conditions can be used to target future interventions to improve disability outcomes. Both aims examine recovery as well as deterioration and the effects of hypothesized risk (e.g., obesity) and protective (e.g., education) factors on disability outcomes. Analysis involves multilevel and novel geostatistical techniques. We have experience with all proposed assessment and analytic methods, which have adequate (> 80%) power to detect small to moderate effects for all hypotheses. Multiple secondary studies (e.g., fear of falling, life space mobility) will also be pursued.