Boston Early Adversity and Mortality Study (BEAMS): Linking Administrative Data to Long-Term Longitudinal Studies

摘要 不利的童年经历，如贫困、心理社会压力源和环境危害 一直以来都与成人健康状况不佳有关。尽管这种早期的逆境对公共卫生具有重要意义，但 “童年长臂”导致晚年发病率的过程，包括以下结果 阿尔茨海默病和相关的痴呆症、心脏代谢性疾病以及最终的死亡率在很大程度上仍然存在 未知。这一领域的科学进步受到两个固有限制的严重阻碍 所有关于衰老的纵向研究：(1)依赖于对早期状况的回顾评估，以及(2) 关于儿童和老年之间的中间过程的“寿命数据”不充分。波士顿早些时候的。 逆境与死亡研究(BEMS)将利用高质量的数据解决回溯数据的局限性 行政备案链接。在目标1中，我们将早期健康、家庭和 来自多个数据库的环境危害(包括最近数字化的生命和人口普查记录， 医院和军事记录、关于水和空气中铅暴露的公共数据)到收集的纵向数据 对自1938年(N=724)或1961年(N=2280)以来重复接受评估的三组男性 大波士顿地区。我们将联系扩展到同龄人的兄弟姐妹，包括女性，并允许家庭内部 比较。随着队列中74%-94%的人死亡，记录联系将创造一个异常丰富的摇篮-- 死亡数据集。在目标1中，我们检验了这样的假设，即早期的逆境在心理社会中(例如，寒冷或 混乱的家庭环境)、社会经济(例如，贫穷的社区)和环境(例如，铅 暴露)领域对老年男性和女性的健康状况不佳有独立和相加的影响。致信地址 上面提到的第二个限制，Aim 2弥合了传递效果的过程的知识鸿沟 早期逆境对三种与年龄相关的结果的影响：阿尔茨海默病和相关的痴呆， 心脏代谢性疾病和全因死亡。利用这些队列中从摇篮到坟墓的数据，我们测试 关于社会经济(低社会经济地位)和心理社会资源不足(低)的中介假设 社会支持、外向性和责任心)，以及有限的认知储备作为候选路径。我们 将检查这些媒介作为特定年龄的水平和成年后的长期轨迹。我们将使用 协调的数据分析方法，告知3个国家的调查结果的可复制性和可推广性 社会经济等级的队列。这些目标的实现将推进最先进的方法和因果关系 了解早期疾病的多个维度如何影响阿尔茨海默氏症等晚年健康结局 疾病和相关痴呆、心脏代谢性疾病和死亡风险。预计调查结果将为 针对早期逆境的上游决定因素的政策和干预努力，并最终延长 健康的跨度。

ABSTRACT Adverse childhood experiences, such as poverty, psychosocial stressors, and environmental hazards, have been consistently linked to poor adult health. Despite the public health significance of such early adversity, the processes by which the “long arm of childhood” brings about morbidity in later life, including outcomes such as Alzheimer's disease and related dementias, cardiometabolic disease, and ultimately, mortality, remain largely unknown. Scientific progress in this area has been severely handicapped by two limitations intrinsic to nearly all longitudinal studies of aging: (1) reliance on retrospective assessments of early conditions, and (2) inadequate “lifespan data” on the intervening processes between childhood and old age. The Boston Early Adversity and Mortality Study (BEAMS) will tackle the limitation of retrospective data by using high-quality administrative record linkage. In Aim 1, we link contemporaneous information on early-life health, family, and environmental hazards from multiple databases (including recently digitalized vital and census records, hospital and military records, public data on water- and air-borne lead exposure) to longitudinal data collected on three cohorts of men who have been assessed repeatedly since 1938 (N=724) or 1961 (N=2280) in the greater Boston area. We extend linkage to siblings of the cohorts to include women and allow within-family comparisons. As the cohorts are 74%-94% deceased, record linkage will create an exceptionally rich, cradle- to-death dataset. In Aim 1, we test the hypothesis that early adversities in the psychosocial (e.g., cold or chaotic family environment), socioeconomic (e.g., impoverished neighborhood), and environmental (e.g., lead exposure) domains have independent and additive effects on poor health in older men and women. To address the second limitation noted above, Aim 2 bridges the knowledge gap on processes which transmit the effects of early adversity onto three age-related outcomes: Alzheimer's disease and related dementias, cardiometabolic disease, and all-cause mortality. Leveraging the cradle-to-grave data on these cohorts, we test mediational hypotheses regarding deficiency of socioeconomic (low SES) and psychosocial resources (low social support, extraversion, and conscientiousness), and limited cognitive reserve as candidate pathways. We will examine these mediators as age-specific levels and long-term trajectories in adulthood. We will use a coordinated data analytic approach to inform the replicability and generalizability of findings across the 3 socioeconomically-graded cohorts. Completion of these aims will advance state-of-the-art methods and causal knowledge on how multiple dimensions of early conditions affect late life health outcomes such as Alzheimer's disease and related dementias, cardiometabolic disease, and mortality risk. Findings are expected to inform policy and intervention efforts targeting the upstream determinants of early adversity, and ultimately prolong the span of good health.