BIODEMOGRAPHY--HEALTH, SOCIAL FACTORS & LIFE CHALLENGE

人口统计过程、社会环境和生活挑战与功能状态和疾病密切相关。社会环境，包括社会等级中的地位以及社会网络和支持系统中的联系，影响挑战的暴露并调节其影响。这项生物统计学调查有两个主要目标。首先，我们提出阐述生活挑战与健康之间的关系，探讨社会环境如何影响这种关系。具体而言，我们将：1)确定与保持和恶化健康最密切相关的挑战，并最好地区分这些挑战；2)检查社会联系、支持网络、工具援助和情感支持以及社会活动对健康的成本和收益。我们将确定对于维持身心功能和调节挑战对健康结果的影响最为重要的组成部分；3)在考虑生活事件的时间和严重程度的情况下，探讨累积优势和累积逆境对健康的影响。其次，我们建议探索如何通过纳入健康和压力的生物标记来增强我们对生活挑战、社会环境和健康之间关系的理解。我们将：1)调查压力和慢性疾病的生物学标记与生活事件报告的关联程度；2)检查生物标志物与医生检查数据和自我报告的健康状况之间的关联，并根据死亡证明和户籍数据探索其与生存的联系；3)探索生物标志物在多大程度上可以解释社会环境、挑战和健康之间的关系。我们将使用来自老年人纵向研究的异常丰富的、基于人口的数据。这些数据自1989年以来定期收集，包括关于健康和社会、经济和人口特征的详细回顾性和现状信息。我们建议根据身体检查和血液和尿液样本分析，从1000名参与者的子集中收集健康和生命挑战的生物标志物。我们的分析策略使用两个多变量过程：1)广义线性模型（特别是那些有限因变量）；2)会员模式等级。我们使用这两种技术将利用它们的互补优势来回答我们的研究问题。

Demographic processes, the social environment, and life challenge are intimately interlocked with functional status and illness. The social environment, encompassing position in social hierarchy as well as linkages within social networks and support systems, affects exposure to challenge and mediates its effects. This biodemographic investigation has two primary goals. First, we propose to elaborate the relationship between life challenge and health, exploring how the social environment affects that relationship. Specifically we will: 1) Identify challenges that are most strongly associated with, and discriminate best between, the preservation and deterioration of health; 2) Examine both the costs and benefits to health of social connection, support networks, instrumental assistance and emotional support, and social activity. We will identify the components that are most important for the maintenance of mental and physical functioning and for mediating the effects of challenge on health outcomes; and 3) Explore the effects of cumulative advantage and cumulative adversity on health taking into account both timing and severity of life events. Second, we propose to explore how our understanding of the relationships among life challenge, the social environment, and health can be enhanced by incorporating biological markers of health and stress. We will: 1) Investigate the extent to which biological markers of stress and chronic illness are related to reports of life events; 2) Examine the associations between the biological markers and data from physicians' examinations and self-reported health status, and explore their links to survival based on data from death certificates and the household registry; and 3) Explore the extent to which the biological markers can explicate the relations among the social environment, challenge, and health. We will use unusually rich, population-based data from a longitudinal study of the elderly. These data have been collected periodically since 1989 and comprise detailed retrospective and current status information on health and on social, economic, and demographic characteristics. We propose to collect biological markers of health and of life challenge from a subset of 1000 of the participants based on physical exams, and assays of blood and urine specimens. Our analytical strategy uses two multivariate procedures: 1) generalized linear models (especially those for limited dependent variables); and 2) grade of membership models. Our use of both techniques will exploit their complementary strengths for answering our research questions.