Healthy Aging In Neighborhoods of Diversity Across Life

美国国家衰老研究所（NIA）校内研究计划（IRP）长期以来一直对规范衰老和年龄相关疾病发展的细胞和分子机制感兴趣。该项目在规范老龄化方面进行了基础实验室和纵向临床研究，以解决这些问题。NIA的校内调查人员扩大了该项目的能力，以解决有关少数民族和贫困人口老龄化和健康差异的假设。通过提出与衰老相关的病理状况的发病率和风险差异的基本问题，研究不同种族、民族和经济来源的群体，IRP临床研究人员希望了解环境和遗传风险因素对疾病的重要性。了解黑人和白人在总体寿命、心血管疾病和脑血管疾病方面持续存在的健康差异背后的驱动因素的需求，导致了NIA IRP跨生命周期多样性社区健康老龄化（HANDLS）研究的发展和规划，这是一项以社区为基础的、流行病学驱动的研究工作，旨在重点评估巴尔的摩不同社会经济的非裔美国人和白人的健康差异。这项研究是独一无二的，因为它是一个多学科项目，评估了20年来社会经济地位（SES）高低的黑人和白人参与者的身体参数以及遗传、生物、人口统计学、社会心理和心理生理参数。它还采用新颖的研究工具，移动医疗研究工具，以提高非传统研究参与者的参与率和保留率。初步考试和征聘阶段大约需要3年时间才能完成。研究数据将分为两部分收集。第一部分包括家庭访谈，包括关于参与者健康状况、卫生服务利用、社会心理因素、营养、邻里特征和人口统计的问卷。第二部分将在医学研究车辆上收集，包括病史和体格检查，饮食回忆，认知评估，心理生理学评估，包括心率变异性，动脉厚度，颈动脉超声检查，肌肉力量和骨密度评估，以及实验室测量（血液化学，血液学，氧化应激生物标志物和遗传研究的生物材料）

The National Institute on Aging (NIA) Intramural Research Program (IRP) has been long interested in the cellular and molecular mechanisms of normative aging and age-related disease development. The program has pursued basic laboratory and longitudinal clinical research in normative aging to address these interests. NIA intramural investigators have expanded the program's capacity to address hypotheses about aging and health disparities in minority and poor populations. By posing fundamental questions about differences in rates and risks for pathological conditions associated with aging, studying groups with diverse racial, ethnic, and economic origins, IRP clinical researchers hope to understand the significance of environmental and genetic risk factors for disease. The need to understand the driving factors behind persistent black-white health disparities in overall longevity, cardiovascular disease, and cerebrovascular disease, has led to the effort to develop and plan the NIA IRP Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) study is a community-based, epidemiologically driven research effort designed to focus on evaluating health disparities in socioeconomically diverse African Americans and whites in Baltimore. This study is unique because it is a multidisciplinary project that assesses physical parameters as well as evaluating genetic, biologic, demographic, psychosocial, and psychophysiological parameters of Black and White participants in higher and lower socioeconomic status (SES) over a 20-year period. It also employs novel research tools, mobile medical research vehicles to improve participation rates and retention among non-traditional research participants. The initial examination and recruitment phase will take approximately 3 years to complete. The study data will be collected in two parts. The first part consists of an in-home interview that includes questionnaires about the participant's health status, health service utilization, psychosocial factors, nutrition, neighborhood characteristics, and demographics. The second part will be collected on the medical research vehicles and includes medical history and physical examination, dietary recall, cognitive evaluation, psychophysiology assessments including heart rate variability, arterial thickness, carotid ultrasonography, assessments of muscle strength and bone density, and laboratory measurements (blood chemistries, hematology, biomarkers of oxidative stress and biomaterials for genetic studies The HANDLS study is a multidisciplinary, prospective epidemiologic longitudinal study examining the influences and interaction of race and SES on the development of cardiovascular and cerebrovascular health disparities among minority and lower SES subgroups. The baseline HANDLS sample will consist of approximately 4,000 community-dwelling African American and white adults aged 30-64. Participants are being drawn from 12 pre-determined census tracts in Baltimore City, sampling representatively across a wide range of socioeconomic and income circumstances. The heuristic study design is a factorial cross of four factors: age, sex, race, and SES with approximately equal numbers of subjects per "cell." HANDLS is planned as a 20-year longitudinal study. Using our mobile medical research vehicles, we will visit each census tract for 3 months and we will re-visit every census tract in a 3-year cycle. The 12 census tracts identified were selected because they are likely to yield representative distributions of individuals between 30 and 64 years old who are African Americans and whites, men and women, and lower and higher SES. Individuals calling themselves multi-ethnics will be included and categorized by the group with which they most strongly identify, but their multi-ethnic identification will be recorded for subsequent statistical analyses. Multi-ethnic individuals who identify strongly with neither African Americans nor whites will be excluded from the present study. Initial estimates based on the 2000 census data indicate that we will need to visit approximately 35% of the households in each census tract to collect the required 333 individuals. The initial sample of 4,000 participants is based on power analyses and assumptions about attrition over 20 years. For a power of 80% (the likelihood of finding an effect if it is really present), we can identify moderate effects (magnitude of the differences between groups) for various outcomes with as few as 30 participants per group at the end of the study. Working backwards by assuming 20% attrition after the baseline assessment and 15% attrition between subsequent assessments, we need approximately 4,000 participants at baseline to yield 1,680 after 20 years. The recruitment phase and initial examination will take approximately 3 years to complete. The study has completed a pilot phase that was conducted in two waves (October 2000-December 2001 and February 2003-November 2003). The epidemiologic phase of the study began in August 2004 with a field based dress rehearsal, currently in progress. The full study will begin on November 1, 2004 in the Reservoir Hill area of Baltimore. Covariates-- Other variables such as nutrition, environment and neighborhood effects, genetic make-up, family history, activity level, access to health care, and prevalent medical, dental, psychiatric conditions, oxidative stress, and DNA repair capacity may modulate the effects of SES and race on cardiovascular, musculoskeletal, cognitive, and autonomic functioning. For example: The nutritional domain of the study will examine the effects of race socioeconomic status (SES) on nutritional status and identify nutritional factors that may contribute to health disparity in cardiovascular and cerebrovascular health and cognitive function. The biomarkers domain of the study will examine possible biologic covariates of health disparities and aging. The early appearance and increased severity of age-associated disease among African Americans and low SES individuals suggests that the factors contributing to the emergence of health disparities may also induce a phenotype of 'premature aging' or "accelerated agin". While we do not posit that health disparities result from genetic alterations in genes associated with the known heritable progeroid syndromes. We do hypothesize that in low SES populations with high rates of early onset age-associated disease the interaction of biologic, psychosocial, socioeconomic and environmental factors may result in a phenotype of accelerated aging biologically similar to these syndromes with increased susceptibility to oxidative stress, premature accumulation of oxidative DNA damage, defects in DNA repair and higher levels of biomarkers of oxidative stress. Health disparities therefore, may be the end product of this complex interaction in populations at high risk. HANDLS will examine this hypothesis by measuring biomarkers of oxidative stress, assessing levels of the most widely studied oxidative DNA adduct, and measuring DNA repair capacity in study participants. Prospectively measuring biomarkers of oxidative stress in a longitudinal study may clarify whether oxidative stress plays a pivotal role in aging and in the development and or progression of age associated disease. It may also provide insights into the different trajectories of aging observed in individuals.