Marital Trajectories and Cardiovascular Disease in the United States

描述(由申请者提供)：本申请提出了一个创新的跨学科项目，将促进我们对婚姻因素如何影响美国老年人心血管疾病(CVD)的发展和进展的理解。这项研究将首次对婚姻轨迹的主要维度(婚姻状况、时间安排、顺序、过渡和持续时间)之间的关联进行全面检查 使用一个结合了概念广度和经验特异性的生命过程框架来预测心血管疾病的发病率和死亡率。这项研究的主要目的有三个：第一，研究时变婚姻轨迹成分与心血管事件(心肌梗死和中风)之间的关系。双变量和多变量分析将提供一些初步证据，表明过去和现在的婚姻经历是否以及在多大程度上会引发男性和女性的急性心肌梗死和中风。第二，研究婚姻因素与心肌梗塞和中风后死亡率(全因和特定心血管疾病)之间的关系。第二组分析将展示婚姻因素在多大程度上影响重大心血管事件后的生存率。第三，调查婚姻轨迹与心血管疾病发病率和死亡率之间的社会经济、心理社会、行为和生理机制。这些假设的机制将作为时变风险进行独立、相加和倍增的评估，以确定它们是否作为婚姻发病率和死亡率差异的调解人和/或调节者。根据累积劣势理论，一般假设是，在结婚风险最低、婚姻最不稳定的人中，心血管衰老的风险积累和加速将最大。这些分析将基于一个由全国有代表性的老年人组成的两年一次的小组(1992-2010)提供的50多年的前瞻性和回溯性数据，并将使用各种基于年龄的方法来阐明婚姻历史的多维随时间变化的影响如何影响重大心血管事件和后续生存的风险。拟议的R03研究将解决我们对主要社会机构如何影响人类健康的理解中的一个重大差距，并将提供新的见解，推动心血管疾病的跨学科研究。了解心血管疾病方面的社会差异，减少弱势群体的疾病负担，是《2020年健康人》和美国国家老龄研究所的主要目标。该项目的结果将为识别疾病高危社会群体提供新的科学，并将提供宝贵的新知识，这些知识可以转化为创新而实用的战略，以预防心血管事件和延长成年心血管疾病患者的生存时间。

DESCRIPTION (provided by applicant): This application proposes an innovative interdisciplinary project that will advance our understanding of how marital factors impact the development and progression of cardiovascular disease (CVD) in U.S. older adults. The research will provide the first comprehensive examination of the associations between the major dimensions of marital trajectories (marital status, timing, sequencing, transitions, and durations) and CVD incidence and mortality using a life course framework that combines conceptual breadth and empirical specificity. The primary aims of this research are threefold: First, to examine the associations between time- varying marital trajectory components and incident cardiovascular events (myocardial infarction [MI] and stroke). Bivariate and multivariate analyses will provide some of the first evidence of whether and to what extent past and present marital experiences precipitate acute MI and stroke in men and women. Second, examine the associations between the marital components and mortality (all-cause and CVD-specific) after MI and stroke. The secondary set of analyses will demonstrate the degree to which marital factors influence survival after a major cardiovascular event. Third, investigate the socioeconomic, psychosocial, behavioral, and physiological mechanisms linking marital trajectories to CVD incidence and mortality. The hypothesized mechanisms will be assessed independently, additively, and multiplicatively as time-varying risks to determine whether they are operating as mediators and/or moderators of marital differences in rates of morbidity and mortality. Drawing from cumulative disadvantage theory, the general hypothesis is that the accumulation of risks and acceleration of cardiovascular aging will be greatest among persons with the least exposure to marriage and most marital instability. The analyses will be based on more than 50 years of prospective and retrospective data from a nationally representative biennial panel (1992-2010) of older adults and will use a variety of age-based methods to elucidate how the multidimensional time-varying effects of marital history impact risks for a major CVD event and subsequent survival. The proposed R03 research will address a significant gap in our understanding of how a major social institution impacts human health and will provide new insights that will advance the interdisciplinary study of CVD. Understanding social disparities in CVD and reducing the excess burden of disease in vulnerable segments of the population are major goals of Healthy People 2020 and the National Institute on Aging. The results of this project will provide new science to identify social groups at high-risk of disease and will provide valuable new knowledge that can translate into innovative yet practical strategies to prevent incident cardiovascular events and prolong survival in adults living with CVD.