Health, Aging and Dementia in South Africa: A Longitudinal Study (HAALSI)

总体-摘要 南非的成年人可以活到老年，但与衰老有关的疾病的负担和风险因素， 尤其是痴呆症和阿尔茨海默氏病，仍然没有明确的定义。到2050年，全球75%以上的 预计痴呆症病例将发生在低收入和中等收入国家（LMICs）。拟议延长 南非的健康、老龄化和痴呆症：一项纵向研究（HAALSI）计划包括四个 由三个核心支持的紧密结合的项目，共同揭示共同的 慢性疾病和认知障碍和痴呆症的其他风险因素。每个项目 依赖于个体调查、认知评估、生物标志物收集和死亡率的共同平台 确定，并针对每个项目采取额外措施。在以往的供资周期（2014-2022年）中，我们 成功收集了5059名≥40岁男性和女性的三波HAALSI Agincourt数据， 在活着的队列成员中实现86-94%的应答率。我们还收集了两波数据， 协调认知评估方案（HCAP），每3年一次。对于此续期申请， HAALSI计划将继续遵循HAALSI阿金库尔队列（目标1），包括原始入组者和 1898年的更新样本，40- 49岁，共13年的纵向数据。我们将进行 HAALSI Agincourt队列子样本的第三个HCAP波，扩展生物标志物，神经影像学， 和临床评估，以了解认知障碍/痴呆、艾滋病毒感染和 心脏代谢疾病（CMD）。在目标2中，我们将确定生物、社会和经济预测因素， 死亡率和痴呆症，并评估疾病的发病率和身体和认知功能的变化， HAALSI阿金库尔队列。此外，在目标3中，我们将试点并启动一项具有全国代表性的队列研究 4500名年龄≥40岁的人及其伴侣（总计约7200人）使用来自 HAALSI Agincourt调查;其中约624人也将接受HCAP。Haalsi National 这项调查将使我们能够估计痴呆症和其他与衰老有关的疾病的患病率， 与社会经济、行为和健康利用暴露的横截面关联。我们将使用 创新的可运输性方法，以评估Agincourt农村社区的疾病与 国家层面在目标4中，我们将评估公共卫生和社会政策对健康的影响， 改善健康的老龄化，特别是那些旨在减少盐的摄入量，并增加财政安全的人， 老年人、家庭和残疾人。最后，在目标5中，我们将最大限度地与 HRS姐妹研究、H3 Africa和DS-I Africa项目， 群体遗传学水平。总之，HAALSI计划将产生有价值的见解的负担， 南非痴呆症和其他衰老相关疾病的驱动因素，为制定有效的 确保健康老龄化和老龄人口福祉的政策。

Overall—Abstract Adults in South Africa are surviving to older ages, yet the burden and risk factors of aging-related diseases, particularly dementia and Alzheimer’s disease, remains poorly defined. By 2050, more than 75% of global dementia cases are projected to occur in low- and middle-income countries (LMICs). The proposed renewal of the Health, Aging and Dementia in South Africa: A Longitudinal Study (HAALSI) Program includes four tightly integrated projects supported by three cores that together will reveal interrelationships among common chronic diseases and other risk factors of cognitive impairment and dementia in South Africa. Each project rests on a common platform of individual surveys, cognitive assessments, biomarker collection, and mortality ascertainment, with additional measures specific to each project. In previous funding cycles (2014-2022), we successfully collected three waves of HAALSI Agincourt data in 5059 men and women ≥40 years of age, achieving response rates of 86-94% among living cohort members. We also collected two waves of data under the Harmonized Cognitive Assessment Protocol (HCAP) at 3-year intervals. For this renewal application, the HAALSI Program will continue following the HAALSI Agincourt cohort (Aim 1), including original enrollees and a refresher sample of 1898, 40- to 49-year-olds, for a total of 13 years of longitudinal data. We will conduct a third HCAP wave on a subsample of the HAALSI Agincourt cohort, with expanded biomarker, neuroimaging, and clinical assessments to understand interactions among cognitive impairment/dementia, HIV infection, and cardiometabolic disorders (CMDs). In Aim 2, we will identify biological, social, and economic predictors of mortality and dementia, and assess disease incidence and changes in physical and cognitive function in the HAALSI Agincourt cohort. In addition, in Aim 3, we will pilot and launch a nationally representative cohort study of 4500 people ≥40 years of age and their partners (approximately 7200 total) using approaches from the HAALSI Agincourt survey; of these, approximately 624 will also undergo the HCAP. The HAALSI National survey will enable us to estimate the prevalence of dementia and other aging-related conditions, and their cross-sectional associations with socioeconomic, behavioral, and health utilization exposures. We will use innovative transportability methods to assess the alignment of diseases in the rural Agincourt community with the national level. In Aim 4, we will evaluate the health impacts of public health and social policies developed to improve healthy aging, specifically those aimed at reducing salt intake, and increasing financial security of older adults, families, and individuals with disabilities. Finally, in Aim 5, we will maximize collaborations with HRS sister studies, H3Africa and DS-I Africa projects, enabling cross-country comparisons and studies at the level of population genetics. Together, the HAALSI Program will produce valuable insights into the burden and drivers of dementia and other aging-related diseases in South Africa, which inform the development of effective policies to ensure healthy aging and wellbeing of aging populations.