Disease, Disability and Death in an Aging Workforce

老龄化劳动力中的疾病、残疾和死亡

• 批准号: 7091810
• 负责人: MARK RICHARD CULLEN
• 金额: $ 101.7万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-06-01 至 2011-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7091810
• 关键词: behavioral /social science research tag; chronic disease /disorder; clinical research; disabling disease; disease /disorder onset; disease /disorder proneness /risk; epidemiology; gender difference; geographic difference; health care quality; health care service utilization; health disparity; health insurance; health services research tag; health surveys; human data; human mortality; human population study; income; job performance; job satisfaction; lifestyle; mathematical model; occupational hazard; occupational stressor; racial /ethnic difference; retirement; socioeconomics; work site

DESCRIPTION (provided by applicant): The overarching goal of this long-term research project is to develop a multilevel model to elaborate the preventable causes of the major chronic diseases of working age adults - hypertension, diabetes, ischemic heart disease, asthma, musculoskeletal and COPD. A corollary is the development of similar models for disability, early retirement and premature mortality. Etiologic factors of a prior interest include: 1) Income, education, job status, ethnicity, gender, "lifestyle" risk factors, and chronic exposure to chemical and physical exposures at work, as well as psycho-social demands of the job, and 2) Factors associated with worksite location including regional health influences, access to and quality of health care, and workplace culture. The proposed multilevel models are designed to explain the heterogeneity in disease incidence, disability and death between worksite locations as a function of individual and job characteristics of workers at each location, as well as differences in the locations themselves. A particular ambition of the project is to identify those differential determinants of chronic disease that accrue during working life, such as cumulative exposures to occupational stressors, presumed in part responsible for the steep gradients in disease prevalence that burden the population after retirement. The empiric data for this comprehensive model will be derived from analyses of a prospective cohort study of the US workforce of Alcoa, a manufacturing company of some 40 thousand men and women geographically distributed at 54 major locations in 24 states. Linking administrative datasets on relevant exposures and health outcomes, supplemented by survey data on a sub-cohort of 5000 individuals at 20 locations, we will address four broad hypotheses: A. A strong SES gradient in the incidence of major chronic diseases, disability and premature death is operating in this geographically, demographically and occupationally diverse US workforce; Components of SES acting separately as well as together contribute to this gradient B. Job strain, shift-overtime, as well as physico-chemical aspects of the work environment are strong and remediable causal factors for the SES gradient; these job factors also contribute to and modify the impact of known social-behavioral risk factors such as smoking and obesity C. Geographic differences, including but not limited to differential utilization of quality health care, contribute to, and perhaps modify, the SES gradient D. Organizational characteristics comprise a set of potent contextual factors which modify the relationships between individual and job related risk factors and health outcomes.

描述（由申请人提供）：该长期研究项目的总体目标是开发一个多层次模型，以详细阐述工作年龄成年人主要慢性疾病（高血压、糖尿病、缺血性心脏病、哮喘、肌肉骨骼和慢性疾病）的可预防原因。慢性阻塞性肺病。一个必然结果是针对残疾、提前退休和过早死亡建立了类似的模型。优先关注的病因包括： 1) 收入、教育、工作状况、种族、性别、“生活方式”风险因素、工作中长期接触化学和物理接触以及工作的心理社会要求，以及2) 与工作场所位置相关的因素，包括区域健康影响、医疗保健的获取和质量以及工作场所文化。所提出的多级模型旨在解释工作地点之间疾病发病率、残疾和死亡的异质性，作为每个地点工人的个人和工作特征以及地点本身的差异的函数。该项目的一个特别目标是确定工作期间产生的慢性病的不同决定因素，例如职业压力源的累积暴露，这可能是导致退休后疾病流行率陡峭梯度的部分原因。该综合模型的经验数据将来自对美国铝业公司 (Alcoa) 劳动力的一项前瞻性队列研究的分析。该公司是一家制造公司，拥有约 4 万名员工，分布在 24 个州的 54 个主要地点。将相关暴露和健康结果的管理数据集联系起来，并辅以 20 个地点 5000 人子队列的调查数据，我们将解决四个广泛的假设： A. 主要慢性疾病、残疾和早产儿的发病率存在很强的 SES 梯度死亡正在影响着地理、人口和职业多样化的美国劳动力； B. 工作压力、加班以及工作环境的物理化学方面是造成 SES 梯度的重要且可补救的因素；这些工作因素也会影响并改变已知的社会行为风险因素（例如吸烟和肥胖）的影响 C. 地理差异，包括但不限于优质医疗保健的差异化利用，会影响并可能改变社会经济地位梯度 D组织特征包括一组有效的背景因素，这些因素改变个人和工作相关的风险因素与健康结果之间的关系。