CHANGES IN HEALTH: SOCIO-ECONOMIC STATUS AND PATHWAYS

在美国、英国和其他工业化国家， 国家死亡率可能会越来越高。这种社会经济（SES）梯度的健康存在 持续到第八个十年。健康随年龄的变化是异质的， 环境因素，包括社会经济地位。我们将建立健康变化的模式和决定因素， 与年龄和社会地位有关。此外，我们将研究是否人内变化的原因和后果， 健康随年龄增长情况与跨部门情况不同。在英国的公务员制度中， 发病率和死亡率的梯度。白厅II研究的广泛的长期目标是解释这些 健康的社会经济差异。WhitehallII研究了10308名年龄在35-55岁之间的男女公务员 在sntry（1985-1988），建立了研究的作用，具体的社会心理，生活方式，生化和生理 这些因素可能解释了这些不平等。这些暴露的真实年龄相关变化，或累积 暴露纵向测量，假设预测的变化，在SES的差异，随着年龄的健康。在10 对队列进行为期一年的随访，NIA支持资助收集数据，以重复健康功能的结果测量， 便秘功能，代谢综合征的组成部分和ApoE基因分型。 该提案的目的是：1。描述和解释与SES相关的健康状况随年龄变化的模式。 2.确定健康功能的梯度从退休前到退休是否不同。3.检查 SES与认知功能随年龄变化的关系。4.研究特定的生物学途径 通过研究社会经济地位随年龄变化的原因和后果，将社会经济地位联系起来。白厅二号研究是独一无二的 为了解决这些问题，提供：公务员就业等级作为SES的一个很好的衡量标准; 纵向设计，参与者在进入时相对年轻，允许检测变化的前因; 暴露的重复测量;广泛的暴露数据;检测年龄相关变化的巨大能力， 与社会经济地位的相互作用;广泛的健康结果，包括健康和认知功能， 代谢综合征、死亡率、非致命性诊断和病假。我们现在申请资金来分析数据 收集到的数据，并为队列15年随访的具体内容做出贡献。通过NIA支持， 第七阶段，我们将能够建立在白厅二。它将使我们能够积累更多的端点并跟踪健康状况 将它们与早期生活和中年接触联系起来，从而使我们能够建立 疾病和健康不平等的心理社会和生物途径。 绩效S\TG（S）（组织、城市、州） 国际健康与社会中心 流行病学和公共卫生部 伦敦大学学院 1-1！）托灵顿广场 伦敦WC 1 E 6 BT 关键人员。参见第11页上的说明。需要使用续页以下列格式提供所需信息。 名称组织项目角色 Michael Marmot教授 (in字母顺序） Eric Branner博士 教授静脉告别UCL Rebecca Fuhrer博士 博士珍妮头伦敦大学学院 Harry Hemingway博士 保罗·希格斯博士 史蒂文·汉弗莱斯教授 主要研究者/主任 合作研究者/高级讲师 顾问/统计员 合作研究者/高级研究员 合作研究者/统计员/ SnLecturer 合作研究者/高级讲师 合作者/讲师 合作研究者/合作者 PHS 35）8（Rev.5/95）第2 BB页 在整个应用程序的底部连续编号页面。不要使用后缀，如3a，3b。 主要研究者/项目负责人（最后，中间）：Marmot，Michael Gideon Meena Kumari博士UCL共同研究者/研究员 Pekka Martikainen博士伦敦大学学院研究员 Gill Mein女士UCL博士研究员 Dr Martin Shipley UCL Senior Lect/Staff Stephen Stansfeld博士UCL共同研究者/共同主任/读者 1 O Q 0个） O CC 我 ¿¿ u O O F 'HS 39 B（Rev.5/9 S）第L页 在整个应用程序中，页面的编号是连续的，不要使用后缀，如3a，3b。 CC首席研究员/项目总监（最后一位，第一位，中间）：Marmot，Michael Gideon 在打印的页面和每个续页的拓扑中键入主要研究者/项目负责人的姓名。（有关类型规范，请参见 第6页上的说明。） 研究资助 目录 页码 FacePage 1 具体实施方式

Social class differences in mortality, morbidity and health functioning persist in the USA, UK and other industrialized countries. Indeed for mortality they may be widening. Such socioeconomic (SES) gradients in health are present throughout the lifespan persisting into the eighth decade. Changes of health with age are heterogeneous with important environmental determinants, which include SES. We will establish patterns and determinants of change of health in relation to age and SES. Further, we will examine whether the causes and consequences of within-person changes of health with age are different from those found cross-sectionally. In the British civil service there is an inverse social gradient in morbidity and mortality. The broad long term objective of the Whitehall II study is to explain these socioeconomic differences in health. The WhitehallII study of 10 308 male and female civil servants, aged 35-55 years at sntry (1985-1988), was established to examine role of specific psychosocial, lifestyle, biochemical and physiological factors as possible explanations of these inequalities. True age related changes in these exposures, or cumulative exposure measured longitudinally, are hypothesized to predict changes in SES differences in health with age. At the 10 year follow up of the cohort, NIA support funded collection of data to repeat outcome measures of health functioning, costive functioning, components of the metabolic syndrome and ApoE genotyping. The aims of the proposal are: 1. To describe and explain patterns of change with age in health status in relation to SES. 2. To determine if the gradient in health functioning differs from pre-retirement to retirement. 3. To examinethe relationship between SES and change in cognitive function with age. 4. to investigate specific biological pathways linking SES by examining the causes and consequences of their change with age. The Whitehall II study is uniquely po:ised to address these questions, offering: civil service employment grade as an excellent measure of SES; longitudinal design with participants comparatively young at entry allowingthe detection of antecedents of change; repeated measures of exposures; a wide range of exposure data; substantial power to detect age-related change, and its interaction with SES; wide range of health outcomes includinghealth and cognitive functioning, components of the metabolic syndrome, mortality, non-fatal diagnoses and sickness absence. We now request funding to analyze the data collected to date and to contribute to specific elements of the 15year follow-up of the cohort. With NIA support for Phase 7, we will be able to build on Whitehall II. It will enable us to accumulate more endpoints and track health functioning into older age, relate them to early life and mid-life exposures, and thereby allow us to establish psychosocial and biological pathways of disease and health inequalities. PERFORMANCE S\TG(S)(organization, city, state) International Centre for Health & Society DepC of Epidemiology & Public Health University College London 1-1!) Torrington Place London WC1E 6BT KEY PERSONNEL.SeeInstructionson Page 11.Usecontinuationpagesasneededto providetherequiredinformation inthe format shown below. Name Organization Role onProject Professor Michael Marmot UCL (in alphabetical order) Dr Eric Branner UCL Professor Vein Farewell UCL Dr Rebecca Fuhrer UCL Dr Jenny Head UCL Dr Harry Hemingway UCL Dr Paul Higgs UCL Professor Steven Humphries UCL Principal Investigator/ Director Co-Investigator / Senior Lecturer Consultant/Statistician Co-Investigator/Senior Res Scientist Co-Investigator/ Statistician/ SnLecturer Co-Investigator/ Senior Lecturer Collaborator/Lecturer Co-Investigator/Collaborator PHS 35)8 (Rev.5/95) Page 2 BB Number pages consecutively at the bottom throughout the application. Donoj use suffixes such as 3a, 3b. PrincipalInvestigator/ProgramDirector (Last,ffrsl.middle): Marmot, Michael Gideon Dr Meena Kumari UCL Co-Investigator /Research Fellow Dr Pekka Martikainen UCL ResearchFellow Ms Gill Mein UCL Doctoral Fellow Dr Martin Shipley UCL Senior Lect/Statistician Dr Stephen Stansfeld UCL Co-Investigator/Co-Director/Reader 1 O Q 0) O CC i ¿¿ u O O F'HS39B(Rev.5/9S) Page_L Mumber pagesconsecutively al thebottomthroughout the application.Dono/use suffixes suchas3a,3b. CC PrincipalInvestigator/Program Director(Last, first, middle): Marmot, Michael Gideon Typethe name ofthe principalinvestigator/programdirector atthe topofeachprintedpageandeach continuation page.(Fortypespecifications,see instructions onpage 6.) RESEARCHGRANT TABLE OF CONTENTS PageNumbers FacePage 1 description,