Health Effects of Racial Segregation on Aging Adults

种族隔离对老年人健康的影响

• 批准号: 7498458
• 负责人: JOSEPH J SUDANO
• 金额: $ 19.57万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-30 至 2010-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7498458
• 关键词: Address; Adult; African; African American; Age; Age-Years; Aging; Area; Cardiovascular Diseases; Censuses; Cessation of life; Characteristics; Chronic; Cities; Cohort Studies; Communities; Community Health; Community Health Systems; Condition; Consensus; County; Cross-Sectional Studies; Crowding; Data; Differential Mortality; Discrimination; Distal; Economics; Enrollment; Equation; Ethnic Origin; Ethnic group; Geographic Locations; Health; Health Policy; Health Status; Health behavior; Hispanics; Housing; Incidence; Individual; Infant; Intervention; Investigation; Knowledge; Label; Lead; Life; Link; Literature; Logistic Regressions; Longitudinal Studies; Measures; Mediating; Mediation; Mental Health; Methods; Minority Groups; Modeling; Neighborhoods; Not Hispanic or Latino; Outcome; Pathway interactions; Patient Self-Report; Physical Function; Policies; Poverty; Proxy; Purpose; Race; Range; Rate; Relative (related person); Research; Research Personnel; Resources; Retirement; Sampling; Schools; Series; Services; Shapes; Social Network; Socioeconomic Status; Specific qualifier value; Stratification; Structure; System; Testing; Time; To specify; Unemployment; United States; Work; base; design; ethnic minority population; experience; member; metropolitan; mortality; multilevel analysis; programs; prospective; racial and ethnic; segregation; social

DESCRIPTION (provided by applicant): Study Purpose. Health status is determined by inputs at both the individual and community level. Racial residential segregation (RRS) is a community attribute proposed to influence health and health status. Yet its effects may be correlated with and mediated by characteristics of communities and their residents. The extent to which RRS influences health and the pathways through which it exerts effects have not been fully explored. This study will: 1) determine the independent effect of several global and local RRS measures in explaining changes in health status after adjusting for community and individual-level effects; 2) specify pathways and mechanisms by which these RRS measures influence change in health using community and individual level mediating factors; and 3) compare the relative explanatory power of these RRS measures and determine whether the mediation mechanisms vary across these measures. Methods: Nationally representative data from the Health and Retirement Study, a large prospective cohort study of approximately 4690 white, 1198 black and 590 Hispanic adults 51 to 61 years of age at enrollment will be merged with data from the Area Resource File and US Census. Guided by our conceptual model, we will develop operational measures for economic, social, physical and health system community characteristics potentially located on the path between RRS and health status. We use spatial and aspatial measures, both two-group (black/white or Hispanic/white) and multi-group (white/black/Hispanic) design, determined at the global (i.e., metropolitan or city) and the local or census tract level. Measures of individual-level SES, health behaviors, and chronic conditions will be included in our model. We will examine the relationship between RRS and health using the following health outcomes based on self-reports of 1) a major decline, no change, or improvement in health from 1992 to 2002; 2) a major decline or death, no change, or improvement in health from 1992 to 2002; 3) a continuous measure using transformed values of the self-reports including death; and 4) changes in physical limitations in a) mobility, b) agility, or c) facility between 1992 and 2000. Race/ethnicity-stratified hierarchical/multilevel modeling and logistic regression will be used to assess the association between RRS and health status, after controlling for community and individual-level characteristics. Race/ethnicity-stratified structural equation modeling will be used to delineate the mediating pathways between RRS, community and individual-level characteristics, and health status. Significance: The current proposal is one of the first studies to use longitudinal data to explore potential causal pathways between RRS and health. Understanding mediation and moderation in these pathways will advance our current understanding of the importance of community level factors on health and will re-focus policy decisions on the need for interventions that address these fundamental causes of disparities in health status.

描述（由申请人提供）：学习目的。健康状况由个人和社区层面的投入决定。种族住宅隔离（RRS）是建议影响健康和健康状况的社区属性。然而，它的影响可能与社区及其居民的特征相关并介导。 RRS影响健康及其发挥作用的途径的程度尚未得到充分探索。这项研究将：1）确定几种全球和地方RRS措施在调整社区和个人水平效应后的健康状况变化方面的独立效果； 2）指定这些RRS衡量的途径和机制使用社区和个体介导因子影响健康的变化； 3）比较这些RRS测量的相对解释力，并确定调解机制在这些措施中是否有所不同。方法：来自卫生和退休研究的全国代表性数据，一项大量的前瞻性队列研究对入学率的大约4690名白色，1198个黑人和590名西班牙裔成年人51至61岁，将与该地区资源文件和美国人口普查的数据合并。在我们的概念模型的指导下，我们将针对经济，社会，身体和卫生系统社区特征制定运营措施，该特征可能位于RRS和健康状况之间的路径上。我们使用两组（黑色/白色或西班牙裔/白色）和多组（白/黑/黑/西班牙裔）设计的空间和大量措施，在全球（即大都市或城市）以及本地或人口普查区域确定。我们的模型将包括个人级别SES，健康行为和慢性病的度量。我们将根据自我报告的以下健康成果来检查RRS与健康之间的关系1）从1992年到2002年的自我报告1）重大下降，没有变化或健康状况的改善； 2）从1992年到2002年，重大衰落或死亡，没有改变或改善健康； 3）使用自我报告的转化值（包括死亡）的连续度量； 4）a）移动性，b）敏捷性或c）1992年至2000年之间的设施发生变化。种族/种族分层的层次/多层次/多层次建模和逻辑回归将用于评估RRS与健康状况之间的关联，在控制社区和个人级别的特征之后。种族/种族分层的结构方程建模将用于描述RR，社区和个人水平特征以及健康状况之间的中介途径。意义：当前的提案是最早使用纵向数据来探索RRS与健康之间潜在的因果途径的研究之一。了解这些途径中的调解和适度将提高我们目前对社区层面因素对健康的重要性的理解，并将重新将重点的政策决策决定干预措施的需求，以解决这些基本原因造成健康状况差异的基本原因。