Chronic disease and healthy ageing at the intersections: social locations, biomarkers, and health practices;

慢性疾病带来巨大的个人和社会成本，并对公共卫生构成重大挑战。此外，它们也是晚年（50岁以上）健康不平等的主要驱动因素。迄今为止，对健康不平等的研究往往侧重于健康如何根据单一类别的差异（如性别或社会经济地位）而变化。然而，在现实世界中，我们知道任何给定的人不仅仅是男人或女人，贫穷或富有等，而是属性的组合，因此我们可能会描述一个年长，贫穷，少数民族的人，例如（或任何其他存在的组合）。这个项目采用了一种理论来解决这种称为交叉性的复杂性。它特别关注性别、年龄、社会经济地位和种族（在老龄化研究中，通常也包括退休和婚姻状况）相互作用的每种可能组合如何与社会结构中的特定位置相关联，从而带来特定（但重叠）的资源、政策影响、过程和歧视类型。反过来，每个位置都与一组特定的（但重叠的）健康社会决定因素相关，对慢性疾病的结果有不同的影响。不同的交叉位置也可能导致不同的文化和社会身份。例如，一个年轻的失业男子的身份可能有一些独特的方面，不能仅仅归结为年龄、就业状况或性别。在这个项目中，我们对2型糖尿病、心脏病和肥胖等慢性疾病特别感兴趣。这些情况非常普遍，并具有共同的社会决定因素。我们将分析来自英国老龄化纵向研究、欧洲健康、老龄化和退休调查、理解社会和英国生物银行的调查数据，以确定哪些交叉位置具有这些条件的特别风险。然后我们将调查哪些因素可能导致这种额外的风险。我们计划关注两类因素。第一个是生命过程中的事件，因为我们知道从子宫到坟墓的不利/优势对以后的生活健康结果至关重要。第二是卫生做法（即社会背景下的卫生行为），因为有强有力的证据表明这些做法会影响慢性病的结局。我们将使用新开发的多层次建模技术和增长曲线模型；这些方法允许社会“绘制”健康结果，并检查它们如何随时间变化。在这项工作中，我们计划分析越来越多地在国际/国家调查中收集的生物标志物数据。生物标志物是潜在病理的客观指标。众所周知的生物标志物包括血压、BMI和糖尿病的HbA1c。其优势在于，生物标志物是健康的客观、有效的衡量标准。此外，通过分析交叉位置的生物标志物结果，我们正在推进一种高度新颖的生物社会方法，将社会学理论与医学测量结合起来。实际上，我们将能够看到社会劣势是如何“深入人心”的，其中性别、年龄和种族等因素相互作用。这项研究的好处是什么？它将突出以前没有引起注意的细微的不平等。它将提出设计、确定目标和调整公共卫生政策和干预措施的新方法。在学术上，它采用了一种理论，这种理论目前被认为对推动健康不平等研究有很大的希望。它将产生新的概念、方法和经验知识，这将对跨多个学科的研究界产生重大兴趣。最终，该项目为采取新方法解决日益严重的慢性疾病负担提供了重要机会，这种负担对许多老年人，特别是处于特别贫困地位的老年人的生活产生了负面影响。

Chronic diseases entail huge personal and societal costs and pose a significant challenge for public health. Furthermore, they are key drivers of inequalities in later life (50+) health. So far, health inequalities research has tended to focus on how health varies according to single categories of difference, such as gender or socioeconomic status. Yet in the real world we know that any given person is not just a man or woman, poor or rich, etc., but a combination of attributes, so that we might describe an older, poorer, ethnic minority man, for example (or any other combination that exists).This project takes up a theory which addresses this complexity called intersectionality. In particular, it focuses on how each of the combinations possible from the interaction of gender, age, socioeconomic status, and ethnicity (and in ageing research, also typically retirement and marital status), is associated with a particular location in the social structure, which brings with it particular (yet overlapping) resources, policy effects, processes, and types of discrimination. In turn, each position is associated with a particular (yet overlapping) set of social determinants of health, with differential consequences for chronic disease outcomes. Different intersectional positions might also entail different cultural and social identities. For example, there might be distinctive aspects to the identity of a younger unemployed man that cannot be reduced to age, employment status, or gender alone.In this project, we are particularly interested in the chronic diseases of type 2 diabetes, heart disease and obesity. These conditions are highly prevalent and have shared social determinants. We will analyse survey data from the English Longitudinal Study of Ageing, the Survey of Health, Ageing and Retirement in Europe, Understanding Society and the UK Biobank to identify which intersectional positions are at particular risk of these conditions. We will then investigate which factors might lead to this excess risk. We plan to focus on two types of factors. The first is events over the lifecourse, since we know that dis/advantage from womb to tomb is crucial to later life health outcomes. The second is health practices (i.e. health behaviours in social context) since there is strong evidence that these influence chronic disease outcomes. We will use a newly developed multilevel modelling technique and growth curve models; these methods allow for socially 'mapping out' health outcomes, and examining how they vary on time.In this work, we plan to analyse biomarker data which is increasingly collected in inter/national surveys. Biomarkers are objective measures of underlying pathology. Commonly-known biomarkers include blood pressure, BMI, and for diabetes, HbA1c. The advantage is that biomarkers are objective, valid measurements of health. Furthermore, by analysing biomarker outcomes at intersectional positions, we are advancing a highly novel biosocial approach, bringing together sociological theory with medical measurements. In effect, we will be able to see how social disadvantage 'gets under the skin' where factors such as gender, age and ethnicity interact with each other.What is the benefit of this research? It will highlight fine-grained inequalities that have previously escaped attention. It will suggest new ways to design, target and tailor public health policies and interventions. Academically, it takes up and runs with a theory which is currently seen as holding great promise to move health inequalities research forward. It will generate new conceptual, methodological and empirical knowledge which will be of substantial interest to the research community across multiple disciplines. Ultimately, the project offers a significant opportunity for a new approach to tackle the growing chronic disease burden negatively affecting the lives of many older people, but especially those in particularly deprived positions.