Disease, Disability and Death in an Aging Workforce Supplement - Racial, Occupational and Socio-economic disparities in driving the 401k Wealth Gap

描述（由申请人提供）：“美国铝业研究”的首要目标是解释40,000多名男性和女性在从工作生活到退休的过程中所表现出的不同的健康和工作能力轨迹。重点关注的结果是突发慢性病、因工致残和死亡率。感兴趣的病因因素包括：1)就业前健康轨迹；2)成人健康行为；3)工作状况和经济报酬；3)工作量，包括体力需求、工时和班次；5)工作的物理环境危害；6)工作的社会心理特征与工作组织；7)卫生保健质量和利用；8)经济周期、工作福利变化、政策干预等外在因素的影响。该应用程序建立在5年的基础设施开发投资和对每个相关结果领域的初步分析之上。主要观察结果包括：1。工作场所的物质和社会心理环境都会增加患慢性病和残疾的风险。2. 就业前和就业后的区域和个人选择因素混淆了工作因素与健康结果之间的关联；管理这种情况的方法仍然不足。3. 体力和心理工作需求在这一人群中比在充分研究的白领人群中更显着的风险；工作“控制”就不那么重要了。4. 在疾病发病率和残疾方面，工业工作场所对妇女的影响似乎比男子更不利。5. 尽管每个地区的全体人口都能统一获得卫生服务，但卫生保健质量与社会经济状况密切相关，而且与社会经济状况和其他（可衡量的）潜在风险无关，其结果也更好。6. 时变的外部事件，如商业周期的下滑和福利的变化，会影响这一人口的健康和工作能力。我们提出了一些额外的数据收集和新模型，最终将1)导致识别工作场所或政策干预的机会，2)最好地利用我们在这些问题的正在进行的研究中的相对优势，如白厅和健康与退休研究。

DESCRIPTION (provided by applicant): The overarching goal of the "Alcoa Study" is to explain the disparate health and work- capacity trajectories demonstrated in this cohort of 40,000+ men and women as they progress from work-life into retirement. Outcomes of focus are incident chronic disease, work-disability and mortality. Etiologic factors of interest include 1) pre-employment health trajectories; 2) adult health behaviors; 3) work status and economic rewards; 3) workload, including physical demands, hours and shifts; 5) physical environmental hazards of work; 6) psychosocial characteristics of work and work organization; 7) health care quality and utilization; and 8) impacts of extrinsic factors such as economic cycles, changes in work benefits and policy interventions. This application builds on 5 years of investment in infrastructure development and initial analyses across each of the relevant outcome domains. Key observations include: 1. Both physical and psychosocial environment in the workplace contribute to risk for development of chronic disease and disability. 2. Pre-employment and post-employment regional and personal selection factors confound associations between work factors and health outcomes; methods to manage this remain inadequate. 3. Physical and psychological work demands are more salient risks in this population than in well studied white-collar populations; work "control" is less so. 4. The industrial workplace appears to impact women more unfavorably than men in terms of both disease incidence and disability. 5. Despite uniform access to health services for the whole population in each area, health care quality is strongly associated with SES, and with better outcomes independent of SES and other (measurable) underlying risks. 6. Time-varying external events, such as down turns in the business cycle and changes in benefits impact health and work capacity in this population. We propose some additional data collection and new models that will ultimately 1) lead to identification of opportunities for intervention in the workplace or in policy, and 2) best exploit our relative advantages among ongoing studies of these issues such as Whitehall and the Health and Retirement Study.