Healthy Aging In Neighborhoods of Diversity Across the Life Span (HANDLS)

HANDLS研究是一项前瞻性、流行病学、纵向研究，通过从巴尔的摩市12个人口普查区的区域概率样本中进行家庭筛查，招募30-64岁的非裔美国人和白人基线代表性样本作为固定的参与者队列。HANDLS设计是基于2000年人口普查的巴尔的摩区域概率样本。使用这种方法，与调查统计学家，我们选择了12个社区，以满足种族的SES的年龄分布，因为他们可能会产生代表性的分布巴尔的摩市有足够的个人，以填补抽样设计的基础。 在12个社区内，住房单元被选择为已知的非零选择机会。 这些地址被筛选出符合年龄-性别-种族-贫困样本量的个人，并使用概率抽样方法选择这些人纳入样本。 从这些概率中，我们可以计算权重来调整不相等的选择概率。 需要这些权重来计算将任何年龄-性别-种族-贫困组的联合收割机受试者组合在一起的估计值。根据2004年《卫生和公众服务贫困准则》的125%，贫困状况指数为125%。 最初的考试和征聘阶段花了大约4年时间完成。研究数据分两部分收集。第一部分包括一个家庭访谈，包括问卷调查参与者的健康状况，卫生服务利用，心理社会因素，营养，邻里特征和人口统计。第二部分是在医学研究车辆上收集的，包括病史和体格检查、饮食回忆、认知评价、心理生理学评估，包括心率变异性、动脉厚度、颈动脉超声检查、肌力和骨密度评估以及实验室测量（血液化学、血液学、氧化应激生物标志物和遗传研究生物材料）。 使用我们的移动的医学研究车辆，我们访问每个人口普查区4个月，我们将重新访问每个人口普查区在3.5年的周期。 HANDLS于2009年3月30日完成了其基线检查波，最终总计招募了3722名参与者。 该队列由2201名非洲裔美国人（59%）和1523名白人（41%）组成。 大约41%的同龄人报告家庭收入低于125%的贫困状况。 在125%贫困线以下的人中，13%是白色人，28%是非洲裔美国人。 在125%以上的贫困人口中，28%是白色人，31%是非洲裔美国人。 样本的平均年龄为47.7岁。 没有与性别或种族相关的显著年龄差异。 低于125%贫困线的参与者比高于125%贫困线的参与者略年轻。 HANDLS体检率为75.2%，与国家健康和营养检查研究（NHANES）的75%体检率相当。第三波考试于2009年7月开始。 对保留战略成功与否的评估尚不完整，但来自前三个被重新访问的社区的数据是有希望的。 到目前为止，我们的中期再接触研究（第2波）在初始基线访视完成后约18个月接触了参与者，能够重新接触2004年至2009年期间最初观察到的约74%的参与者。与纵向研究设计一致的第3波方案保持了许多与基线第1波检查相同的研究领域，包括：认知、心血管疾病、营养、体能、心理学、健康服务、基因组学（遗传学和表观遗传学）和疾病的分子生物标志物。 该方案还包括新的研究领域，特别关注关键的健康差异，包括肾功能，神经解剖学，财务和健康知识。 这些项目涵盖了广泛的临床医学领域，包括大量已建立的少数民族调查人员以及学生和医生的培训。

The HANDLS study is a prospective, epidemiologic, longitudinal study of a baseline representative sample of African Americans and whites between 30-64 years old recruited as a fixed cohort of participants by household screenings from an area probability sample of twelve census segments in Baltimore City. The HANDLS design is an area probability sample of Baltimore based on the 2000 Census. Using this methodology, working with survey statisticians we chose 12 neighborhoods to meet race by SES by age distribution because they were likely to yield representative distributions of Baltimore City with sufficient individuals to fill the sampling design based. Within the 12 neighborhoods, housing units were selected with a known non-zero chance of selection. The addresses were screened for individuals who meet the age-gender-race-poverty sample size, and those were chosen to be included in the sample using a probability sampling method. From these probabilities, we can compute weights to adjust for unequal probabilities of selection. These weights will be needed to compute estimates that combine subjects across any of the age-gender-race-poverty group. The poverty status delimiter is 125% poverty based on 125% of the 2004 Health and Human Services Poverty Guidelines. The initial examination and recruitment phase took approximately 4 years to complete. The study data was collected in two parts. The first part consisted of an in-home interview that includes questionnaires about the participants health status, health service utilization, psychosocial factors, nutrition, neighborhood characteristics, and demographics. The second part was collected on the medical research vehicles and includes medical history and physical examination, dietary recall, cognitive evaluation, psychophysiology assessments including heart rate variability, arterial thickness, carotid ultrasonography, assessments of muscle strength and bone density, and laboratory measurements (blood chemistries, hematology, biomarkers of oxidative stress and biomaterials for genetic studies). Using our mobile medical research vehicles, we visit each census tract for 4 months and we will re-visit every census tract in a 3.5-year cycle. HANDLS completed its baseline examination wave on March 30, 2009 with a final total accrual of 3722 participants. The cohort is comprised of 2201 African American (59%) and 1523 Whites (41%). Approximately 41% of the cohort reported a household income below the 125% poverty status delimiter. Of those below the 125% poverty delimiter, 13 % were white and 28% African American. Of those above the 125% poverty delimiter, 28% were white and 31% African American. The mean age of the sample was 47.7 years. There were no significant age differences associated with sex or race. Participants below the 125% poverty delimiter were slightly younger than those above the delimiter. HANDLS medical examination rate was 75.2% comparable to the 75% examination rate for the National Health and Nutrition Examination Study (NHANES). Wave 3 examinations started in July 2009. Evaluation of the success of the retention strategy is incomplete but data from the first three neighborhoods to be revisited is promising. Thus far our Interim Re-contact Study (Wave 2) which reaches out to participants approximately 18 months after initial baseline visit completion has been able to re-contact approximately 74% of participants initially seen between 2004 and 2009. The Wave 3 protocol in keeping with the longitudinal study design maintains many of the same study domains as the baseline wave 1 examination including: cognition, cardiovascular disease, nutrition, physical performance, psychology, health services, genomics (genetics and epigenetics), and molecular biomarkers of disease. This protocol also includes new areas of study particularly focused on critical health disparities including, renal function, neuroanatomy, financial and health literacy. These are projects that span a broad range of areas of clinical medicine and include a large number of established minority investigators as well as students and physicians in training.