The Study of Women's Health Across the Nation (SWAN): The Impact of Midlife and the Menopause Transition on Health and Functioning in Early Old Age

项目总结 这个U19应用程序被称为天鹅老龄化，旨在确定中年健康的程度， 尤其是更年期过渡(MT)，会影响女性的成功衰老。这项提议充分利用了 关于全国妇女健康研究(SWAN)的丰富资源--纵向队列研究 创建于1994年，旨在描述MT期间发生的生理和心理社会变化。总计 在3302名黑人、中国人、日本人、西班牙裔和白人妇女中，有7个地点招收了妇女，其中74%的人仍然- 活着的妇女从绝经前到绝经后完成最多16次访问。斯旺有 描述了MT的自然历史--它的时间、激素变化的模式和症状--以及他们的 与中年健康指标的关系。在Swan-Aging中，我们将把Swan队列的随访扩展到早期老年 年龄(66-75岁)，并将前瞻性地将MT和 中年健康指标反映早年多个领域的功能和健康状况，这是 当健康和机能方面的不利变化开始累积时，过渡到老年。《环球报》 本U19申请的具体目标是：1)确定MT特征和轨迹的影响 关于认知、身体、生殖器、性和心理社会保护的中年健康指标 老年早期的功能和睡眠；2)确定MT特征和中年轨迹的影响 关于包括跌倒、骨质疏松症和骨折在内的不良健康后果风险的健康指标很差 心脏代谢功能、心血管事件和早期死亡率；3)决定 老年早期的健康和功能可归因于MT特征的中年种族/民族差异 和中年健康指标；以及4)翻译《天鹅和天鹅--关于妇女及其健康的研究结果》 照顾者。这些目标将通过组织的三个综合科学项目来实现 围绕关键健康领域(功能、心脏代谢健康和肌肉骨骼健康)，并通过 共同关注MT的特征和健康指标的中年变化作为关键暴露。三位一体 项目将得到三个核心的支持，这三个核心将a)提供必要的组织基础设施以 进行这项研究并向研究和医学界传播结果；b)进行准确、 大容量分析，根据需要采用新方法提供最先进的实验室数据，以及c) 监督核心诊所访问的设计和实施、数据收集和数据管理以及创建 分析数据集的。Swan-Aging将包括一次诊所访问和全国死亡指数搜索，以确保 完全确定队列的死亡率。天鹅老化具有独特的地位，可以填补重要的科学 对MT和中年指标对#年妇女健康和机能的影响认识上的差距 早年并促进将新知识应用于临床实践。这项研究将提供 对与未来预防和治疗计划的设计相关的可修改因素的有价值的见解。

PROJECT SUMMARY This U19 application, referred to as SWAN-Aging, is designed to determine the extent to which midlife health, and specifically the menopause transition (MT), affects successful aging in women. This proposal capitalizes on the rich resources of the Study of Women's Health Across the Nation (SWAN), a longitudinal cohort study initiated in 1994 to characterize the physiological and psychosocial changes that occur during the MT. A total of 3302 Black, Chinese, Japanese, Hispanic and White women were enrolled at seven sites, with 74% of still- living women completing up to 16 visits spanning the pre-menopause to post-menopause. SWAN has described the natural history of the MT -- its timing, patterns of hormonal changes, and symptoms – and their relation to midlife health indicators. In SWAN-Aging, we will extend follow-up of the SWAN cohort into early old age (66-75 years) and will prospectively link comprehensive longitudinal characterization of both the MT and midlife health indicators to functioning and health across multiple domains in early old age, a pivotal time of transition into old age when adverse changes in health and functioning begin to accumulate. The global specific aims of this U19 application are to: 1) determine the impact of MT characteristics and trajectories of midlife health indicators on the preservation of cognitive, physical, genitourinary, sexual, and psychosocial function and sleep in early old age; 2) determine the impact of MT characteristics and trajectories of midlife health indicators on risk of adverse health outcomes, including falls, osteoporosis and fractures, poor cardiometabolic function, cardiovascular events and early mortality; 3) determine if racial/ethnic disparities in health and functioning in early old age are attributable to midlife racial/ethnic differences in MT characteristics and midlife health indicators; and 4) translate the SWAN and SWAN-Aging findings for women and their health care providers. These aims will be achieved through three integrated scientific Projects that are organized around key health domains (functioning, cardiometabolic health and musculoskeletal health) and linked by a common focus on MT characteristics and midlife changes in health indicators as key exposures. The three Projects will be supported by three Cores which will a) provide the necessary organizational infrastructure to conduct this study and to disseminate results to the research and medical communities; b) conduct accurate, high volume assays, adopting new methods as needed to provide state-of-the-art laboratory data, and c) oversee the design and conduct of the core clinic visit, data collection and data management, and the creation of the analytic datasets. SWAN-Aging will include one clinic visit and a National Death Index search to ensure complete mortality ascertainment for the cohort. SWAN-Aging is uniquely positioned to fill important scientific gaps in understanding of the impact of the MT and midlife indicators on women's health and functioning in early old age and to facilitate the application of new knowledge to clinical practice. This study will provide valuable insights into modifiable factors relevant to the design of future prevention and treatment programs.