Communities Designed to Support Cardiovascular Health for Older Adults

 描述(由申请者提供)：商业机构有可能塑造个人行为，包括饮食摄入、体力活动模式和慢性医疗条件的管理，所有这些都与心肌梗死和相关心血管疾病(CVD)的结果相关。针对当地企业的政策战略可能在预防心血管疾病、延长健康寿命和促进独立生活方面发挥重要作用。我们建议将商业上可用的“大数据”和详细的基于人口的队列数据结合在一起，以研究当地商业环境在心血管疾病中的作用，以及数十年来出现的种族差异在心血管疾病中的作用。对当地环境的纵向研究被强烈建议作为未来研究的方向，以促进我们对因果邻里关系对健康影响的理解。与心血管疾病潜在相关的当地企业密度随着时间的推移而变化，这种时间波动因地区、城市和社区而异。这些差异可以用来研究居住稳定的老年人如何受到当地环境的影响。与此同时，搬到新住址的老年人可能会通过改变健康行为来回应他们的新环境，这为因果关系提供了另一个窗口。然而，需要仔细注意导致搬迁的急性健康变化，以及尽管有新的健康或功能限制，但当地环境特征预测老龄化的存在。在拟议的项目中，我们将联系纵向数据来调查社区变化和住宅搬迁如何影响心血管健康和健康差距。我们将使用全国性企业的普查，即国家机构时间序列(NETS)。美国5240万个商业机构的NETS数据包括1990-2012年的年度点级地理编码和商业特征，这为在多个空间尺度上表征全国不断变化的商业环境提供了前所未有的机会。地理环境数据(来自网络以及纵向人口、安全和交通数据)将链接到来自 两项正在进行的队列研究：心血管健康研究(CHS)和中风地理和种族差异的原因(CONTS)研究。CHS是一项以人群为基础的研究，涉及5888名老年人(基线年龄在65岁以上的100%，女性58%，非裔美国人16%)。大多数CHS参与者在1990-1993年间从四个美国网站注册，其中 对非裔美国人的过度抽样，在他们的余生中一直被前瞻性地跟踪，使得能够深入描述老年人在他们最后几十年所经历的邻里环境。READES也是一项基于人群的前瞻性队列研究，对非裔美国人进行过度抽样，从而能够检查种族差异。然而，30,239名参与者(基线年龄在65岁以上的占49%，女性占55%，非裔美国人占42%)是最近(2003-2007年)和更广泛的地理区域(美国48个毗邻的州，过度抽样中风带居民)登记的。对于这两个优势互补的队列，心血管事件已被确定，并收集了纵向地址数据。该项目汇集了无与伦比的数据资源，以政策相关工作的记录为基础，利用了大量的地理数据资源，并利用了全面的心血管队列数据。

 DESCRIPTION (provided by applicant): Business establishments have the potential to shape individual behaviors including dietary intake, physical activity patterns, and management of chronic medical conditions, all with relevance to risk of myocardial infarction and related cardiovascular disease (CVD) outcomes. Policy strategies targeting local businesses may play an important role in CVD prevention, extending years of healthy life, and facilitating independent living. We propose to bring together commercially available "big data" and detailed population-based cohort data to examine the role of local business environments in CVD and racial disparities in CVD as they emerged across decades. Longitudinal studies of local environments have been strongly recommended as a direction for future research to advance our understanding of causal neighborhood effects on health. The local density of businesses with potential relevance to CVD has changed over time, and such temporal fluctuations vary across regions, cities and neighborhoods. These differences can be used to investigate how residentially stable older adults are affected by their local context. Meanwhile, older adults who relocate to a new home address may respond to their new context by changing health behaviors, offering another window into causation. However, careful attention is needed to acute health changes that precipitate relocation, and which local environment features predict aging in place despite new health or functional limitations. In the proposed project, we will link longitudinal data to investigate how neighborhood change and residential relocation shape cardiovascular health and health disparities. We will use a census of national businesses, the National Establishment Time Series (NETS). NETS data for all 52.4 million US business establishments includes annual point-level geocodes and business characteristics for the years 1990-2012, offering an unprecedented opportunity to characterize changing business environments nationally at multiple spatial scales. Geographic context data (from NETS as well as longitudinal population, safety, and transportation data) will be linked to individual data from two ongoing cohort studies: the Cardiovascular Health Study (CHS) and the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. CHS is a well-characterized population- based study of 5,888 older adults (100% age 65+ at baseline, 58% female, 16% African American). A majority of the CHS participants enrolled 1990-1993 from four US sites, with oversampling of African Americans, have been followed prospectively for the remainder of their lives, allowing in-depth characterization of neighborhood environments experienced by older adults in their final decades. REGARDS is also a prospective population-based cohort study with oversampling of African Americans, allowing for examination of racial disparities. However, the 30,239 REGARDS participants (49% age 65+ at baseline, 55% female, 42% African American) were enrolled more recently (2003-2007) and from a broader geographic region (48 contiguous US states, oversampling Stroke Belt residents). For these two cohorts with complementary strengths, cardiovascular events have been ascertained and longitudinal address data collected. This project brings together unparalleled data resources, builds on a track record of policy-relevant work with large geographic data resources, and leverages comprehensive cardiovascular cohort data.