Understanding Social Disparities in Health and Aging

描述(由申请人提供)：这项相互竞争的更新提案中描述的研究旨在通过五个目标来维持和加强美国人改变生活(ACL)研究，该研究始于1986年，是对广泛的社会经济和心理社会决定因素以及健康和健康差距如何在整个生命过程中发挥作用的最古老的、具有全国代表性的前瞻性研究。这是一个独特的研究项目和主要的公共使用数据集，用于分析和了解健康随年龄变化的社会差异，特别是推迟或压缩整个成人生命过程中死亡率、发病率、功能限制和残疾的差异。该研究侧重于并有助于美国公共卫生服务2010年健康人群战略计划的两个总体目标：1)增加健康的活动预期寿命；2)减少健康方面的社会差距。这项建议的五个具体目标是：1)通过进行第五波数据收集和使用国家死亡指数、死亡证书验证和其他死亡跟踪过程至少到2013年进行第五波数据收集和持续的年度死亡率确定，延长对1986年ACL样本幸存成员的纵向跟踪；2)为前交叉韧带制定方法学/生物统计学核心，它将a)为该项目提供专业知识，以便对健康中长期变化和轨迹的决定因素进行日益复杂的分析，以及b)开发和应用创新的统计/方法学研究，以改进纵向分析，并针对分析中的选择和磨损进行调整，从而提高我们和其他人利用前交叉韧带和类似纵向数据的能力；3)了解发病率和死亡率及其压缩方面的社会差异的机制；4)在第5波ACL中增加关于医疗、残疾和损伤的新措施，以扩大研究中的健康状况结果，并调查选定的生物医学干预措施在维持、加强或缓解不同健康结果随年龄变化的社会差距方面的作用；以及5)利用现有的工作条件和过渡措施，并在ACL5中增加新的措施，以便在当前美国和世界经济危机的背景下，调查有偿工作、无偿生产活动和“退休”的变化模式和顺序。

DESCRIPTION (provided by applicant): The research described in this competing renewal proposal seeks through five aims to maintain and enhance the Americans' Changing Lives (ACL) study, which was started in 1986, and is the oldest on-going nationally- representative prospective study of a broad range of socioeconomic and psychosocial determinants of health, and of how health and health disparities play out over the full life course. It is a unique research project and major public use data set for analyzing and understanding social disparities in the way health changes with age, especially the postponement or compression of mortality, morbidity, functional limitations, and disability over the entire adult life course. The ACL study focuses on and contributes to the two overarching goals of the U.S. Public Health Service's Healthy People 2010 strategic plan: 1) increasing healthy active life expectancy and 2) reducing social disparities in health. The five specific aims of this proposal are: 1) to extend the longitudinal follow-up of surviving members of the 1986 ACL sample by conducting a fifth wave of data collection and continuing annual mortality ascertainment using the National Death Index, death certificate verification, and other mortality tracking processes through at least 2013; 2) to develop a methodological/biostatistical core for ACL which will a) provide expertise to the project for increasingly complex analyses of the determinants of long term changes and trajectories in health, and b) develop and apply innovative statistical/methodological research to improve longitudinal analysis and adjust for selection and attrition in analyses, thus, improving our and others' ability to utilize ACL and similar longitudinal data; 3) to understand mechanisms underlying social disparities in morbidity and mortality and the compression thereof; 4) to add new measures regarding medical care, disability and impairment to ACL Wave 5 so as to expand the health status outcomes under study and investigate the role of selected biomedical interventions in maintaining, enhancing or alleviating social disparities in the way different health outcomes change with age; and 5) to capitalize on existing measures of work conditions and transitions and add new ones to ACL5 in order to investigate changing patterns and sequencing of paid work, unpaid productive activities, and "retirement", in the context of current crises of the American and world economies.