Implications of residential location in midlife disability and cognitive functioning among the poor vs. rich: within the US and cross-country comparisons

项目摘要/摘要 尽管美国在医疗保健方面的支出比其他高收入国家多得多，但美国的医疗保健和 美国劳动年龄成年人的预期寿命有所下降，在其他领域进一步落后于同龄人 国家。确定健康恶化风险最大的人群并确定关键因素 对美国人口日益扩大的健康差距做出贡献是极其重要和及时的。这个 该项目的总体目标是阐明决定美国中年健康的多层次因素， 重点关注残疾和认知功能结果。 我们将首先关注美国国内的比较，以确定特定地点的上下文因素在 美国劳动年龄成年人的残疾和认知功能。我们将使用准- 实验方法，以加强可归因于地点水平与个人的边际影响的检测- 水平因素；我们比较具有相似个人水平特征和资源的成年人，但生活在 具有不同地点级别上下文的区域。我们将考察多层次地理环境的背景因素 地区级社会脆弱性和建成环境、县级社会方案和 资源，以及州一级的社会保障和医疗保健政策。我们还将利用生命历史 提供整个生命过程中的居住历史的数据，以帮助低估暴露的水平 并根据生命阶段不同而产生不同的影响。 然后，我们将确定导致美国中年残疾和认知障碍相对地位的因素 与其他高收入的欧洲国家相比，这些国家的经济运行状况更好。我们将使用协调的调查数据 来自健康和退休研究(HRS)、英国老龄化纵向研究(ELSA)和调查 欧洲的健康、老龄化和退休(份额)。我们将评估在多大程度上国家层面 经济不平等、医疗保健制度和社会保护政策影响了 在美国，在低SES和高SES的成年人中。然后我们将考察当地因素在多大程度上 通过利用和扩展这项研究，促进各国结果的差异 团队的新程序，以协调各国的本地上下文数据并将 将上下文数据添加到每个调查。 这项研究将有助于澄清地理位置的社会经济、自然和制度因素 多层次情境因素与个体层次交叉对中年健康的影响 社会经济特征。该项目还将为#年的比较评估提供数据。 通过生成协调高收入人群的本地地区数据来实现跨国健康差距 这些数据将完全按照保密数据保护政策发布。 1

PROJECT SUMMARY/ABSTRACT Despite that the US spends much more on healthcare than other high-income countries, the health and life expectancy of US working-age adults has declined, losing ground further to their peers in other countries. Identifying those most at risk for worsening health and determining the key factors contributing to the widening health disparities in the US population is critically important and timely. The overarching goal of this project is to clarify the multi-level factors in determining US midlife health, focusing on disability and cognitive functioning outcomes. We will first focus on within-US comparison determining the role of place-specific contextual factors in disability and cognitive functioning among working-age adults in the US. We will use a quasi- experimental approach to enhance detecting marginal effects attributable to place-level vs. individual- level factors; we compare adults with similar individual-level characteristics and resources but living in areas with different place-level contexts. We will examine contextual factors of multi-level geographic units such as tract-level social vulnerability and built environment, county-level social programs and resources, and state-level social protection and healthcare policy. We will also capitalize on life-history data that provide residential histories over the entire life course to help understate the level of exposure and differential effect by life stage. We will then identify factors contributing to the relative position of US midlife disability and cognitive functioning compared to other high-income European countries. We will use harmonized survey data from the Health and Retirement Study (HRS), English Longitudinal Study of Ageing (ELSA), and Survey of Health, Ageing and Retirement in Europe (SHARE). We will assess the extent to which national-level economic inequality, healthcare system, and social protection policies affected the relative position of the US among low- vs. high-SES adults. We will then examine the extent to which local-area factors contribute to the difference in the outcomes across countries by leveraging and extending the study team’s novel procedure to harmonize local-area contextual data across countries and link the contextual data to each survey. This study will contribute to clarifying socioeconomic, physical, and institutional factors for geographic variation in midlife health by intersecting multi-level contextual factors with individual-level socioeconomic characteristics. The project will also advance data for the comparative assessment in cross-country health disparity by generating the local-area data harmonized across high-income countries, which will be released in full compliance with confidential data protection policies. 1