Racial/Ethnic Differences in Reproductive Aging and Onset of Cardio-metabolic Risk in the Study of Women’s Health Across the Nation: Methodological Challenges in Aging Cohorts

7项目概要/摘要 种族/族裔在预期寿命方面的差异是有据可查的。这些差距主要是由于过度 高血压、心脏病和糖尿病等心脏代谢疾病导致的黑人死亡率。 老化和健康恶化方面的种族/民族差异被认为源于“风化”或早期健康 由于反复经历社会或经济危机的累积影响， 逆境和政治边缘化。为了证实这一理论，研究观察到， 死亡率的差异在中年和老年早期变得更加明显， 代谢性疾病增加，尤其是女性。据推测，中年风险的增加 女性可能与荷尔蒙分泌或生殖衰老的结束有关，这是由女性生殖周期的时间标志的。 末次月经（FMP）然而，目前还不清楚风险的增加是由于生殖老化还是 总的来说是衰老。生殖年龄方面的种族/民族差异的证据是混合的。这可能 部分原因是对老龄化群体的选择偏见，这是由于系统地排除了 经历早期老化（左截断）或采用可能无意中排除高- 风险群体。因为队列的建立是为了评估结局的发生率，如果 招募时不考虑平均老化率，队列可能会受到选择偏差的影响。 此外，由于黑人妇女的手术闭经率较高， 生殖并发症的卵巢切除术/卵巢切除术，他们往往是 系统地排除在生殖老化的估计之外。多种族/民族妇女健康研究 全国范围内（SWAN）招募了42-52岁的女性，不包括那些 手术闭经。SWAN在队列选择的每个阶段都有丰富的数据，使其成为理想的 开发一种统计方法来处理由于左截断而产生的选择偏差。因此，我们建议使用 SWAN开发并证明选择偏倚对种族/民族差异估计的影响， 生殖年龄（目标1）和心脏代谢风险时间的种族/民族差异（目标2a）。我们将 还评估心脏代谢风险的种族/民族差异是否在治疗前或治疗后更明显。 FMP（目标2b）。这项工作将有助于通过开发一种新的统计方法来研究衰老问题， 校正可能错过导致左截断的风险窗口或 有排除标准，导致系统地选择更健康的人。对这种偏差的校正是 在估计平均发病年龄和老龄化中的健康差异时，这一点非常重要。这 研究-通过这项奖学金的支持，密歇根大学和合作， 我尊敬的导师们-将继续推进我的流行病学方法的应用知识，并将 作为一名专注于老龄化中种族/民族差异的独立学者，我的持续成长至关重要。

7 PROJECT SUMMARY/ABSTRACT Racial/ethnic disparities in life expectancy are well documented. These disparities are mainly due to excess mortality among Blacks from cardio-metabolic conditions such as hypertension, heart disease and diabetes. Racial/ethnic disparities in aging and health deterioration are posited to stem from “weathering” or early health deterioration as a consequence of the cumulative impact of repeated experience with social or economic adversity and political marginalization. Corroborating this theory, studies have observed that the racial/ethnic differences in mortality become more pronounced in midlife and early old age when the risk for cardio- metabolic disease increases, particularly for women. It is hypothesized that the increase in risk in midlife women could be related to the end of hormonal production or reproductive aging, signaled by the timing of the final menstrual period (FMP). However, it is unclear if the increase in risk is due to reproductive aging or aging in general. Evidence of racial/ethnic differences in reproductive aging has been mixed. This may be partially due to selection bias into cohorts of aging, caused by systematically excluding women who experience early aging (left-truncation) or employing selection criteria that may unintentionally exclude high- risk groups. Because cohorts are set up to assess the incidence of an outcome, if the potential variability in average rate of aging is not considered upon recruitment, cohorts could be subject to selection bias. Furthermore, as Black women have a higher rate of surgical amenorrhea due to higher rates of hysterectomies/oophorectomies from reproductive complications earlier in life, they are often systematically excluded from estimates of reproductive aging. The multi-racial/ethnic Study of Women's Health Across the Nation (SWAN) recruited women at 42-52 years of age and does not include women who had surgical amenorrhea. SWAN has a wealth of data at each stage of selection for the cohort making it ideal for developing a statistical approach to handling selection bias due to left-truncation. Therefore, we propose to use SWAN to develop and demonstrate the impact of selection bias on estimates of racial/ethnic differences in reproductive aging (Aim 1) and on racial/ethnic differences in timing of cardio-metabolic risk (Aim 2a). We will also assess whether racial/ethnic differences in cardio-metabolic risk are more pronounced before or after the FMP (Aim 2b). This work will contribute to research on aging by developing a novel statistical approach to correct for selection bias in aging cohorts that may miss the window of risk leading to left truncation or that have exclusion criteria that leads to systematic selection of healthier persons. Correction for such bias is principally important when estimating average age of disease onset and health disparities in aging. This research – made possible by the support of this fellowship, the University of Michigan and collaboration with my distinguished mentors – will continue to advance my applied knowledge of epidemiologic methods and will be essential to my continued growth as an independent scholar focused on racial/ethnic disparities in aging.