Disparities in the burden and progression of multi-morbidity across adulthood

成年期多种疾病的负担和进展存在差异

• 批准号: 10610339
• 负责人: Solveig Argeseanu Cunningham
• 金额: $ 37.28万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10610339
• 关键词: Address; Adult; Affect; African American population; Age; Age of Onset; Aging; Arthritis; Asthma; Birth; Cardiometabolic Disease; Cardiovascular Diseases; Caring; Chronic; Chronic Disease; Clinical Practice Guideline; Cohort Studies; Communities; Data; Data Set; Dementia; Diabetes Mellitus; Differential Mortality; Disease; Disease Clusterings; Disease Progression; Disparity; Economics; Elderly; Enrollment; Ethnic Origin; Europe; Gender; Geography; Goals; Guidelines; Health; Health and Retirement Study; Healthcare; Heart Diseases; Hispanic; Hispanic Populations; Hypertension; Incidence; Individual; Institutionalization; Interruption; Intervention; Kidney Diseases; Life; Life Cycle Stages; Life Expectancy; Liver diseases; Longitudinal Studies; Lung diseases; Malignant Neoplasms; Measures; Medical Care Costs; Mental Depression; Modeling; Morbidity - disease rate; Myocardial Infarction; National Longitudinal Survey of Adolescent to Adult Health; National Longitudinal Survey of Youth; Nature; Obesity; Osteoporosis; Pattern; Persons; Policies; Population; Population Group; Premature Mortality; Probability; Procedures; Quality of life; Race; Reasons for Geographic And Racial Differences in Stroke; Research; Risk; Sentinel; Stroke; Time; Work; clinical practice; cohort; data infrastructure; disability; disability risk; disparity reduction; epidemiology study; ethnic minority; experience; follow-up; health disparity; high risk; innovation; lifetime risk; mortality risk; multiple chronic conditions; panel study of income dynamics; prevent; progression risk; racial minority; sex; working class

PROJECT SUMMARY RELEVANCE: Approximately 1 in 4 U.S. adults suffers from multimorbidity, or two or more concurrent chronic diseases. People with multimorbidity experience more disability and higher mortality risk and have higher medical costs than people with 1 chronic condition. Our understanding of the onset and progression of multimorbidity is limited. OBJECTIVES: To develop clinical practice guidelines and interventions, it is necessary to have accurate information about the progression of multimorbidity, the age and timing of onset, and differences in these across population groups. AIMS: 1) Harmonize and bridge national longitudinal data to track the incidence of chronic diseases and multimorbidity in the U.S. starting at age 30. We will combine 7 premier national cohort datasets of adult health (Add Health, NLSY79, NLSY97, PSID, REGARDS, H-EPESE, HRS) to create a synthetic nationally representative cohort of adults starting at age 30 years, compiling over 1.7 million person-years of follow-up and include sizeable number of racial/ethnic minorities. 2) Estimate the progression to multimorbidity starting at age 30 years. We will identify the age-specific progression rate of common chronic disease clusters and the sentinel conditions associated with higher risks of progression to additional diseases. 3) Develop measures of age-specific risk of multimorbidity for the US adult population and calculate the lifetime risk of developing multimorbidity and years spent with multimorbidity. 4) For major race-ethnic, sex, economic, and geographic groups, identify the sentinel conditions, age-specific progression, and lifetime risk of multimorbidity. We will estimate differences across groups and quantify the implications of reducing these disparities on disease-free life expectancy, with the additional innovation of adjusting for biases due to differential mortality and institutionalization. DESIGN: Bridging and reweighting procedures will be applied to develop a new data infrastructure with nationally representative longitudinal birth cohorts and synthetic cohorts. We will use Poisson regression to model the ages at which disparities in multi-morbidity emerge. To capture the sequencing and pacing of multimorbidity, we will estimate the probability of experiencing an additional (k+1th) condition for those with k prior chronic conditions. We will estimate cumulative probabilities based on Kaplan-Meier survival probabilities. Disparities will be quantified using Greenwood’s estimator. IMPACT: This project will advance understanding of the nature, onset, and progression of multimorbidity. To inform clinical practice and healthcare guidelines, we will identify conditional risks of transitioning to additional diseases given age of onset and sentinel disease. With particular relevance to policy, we will model the years of disease-free life expectancy that would be gained by interventions that delay or avert the onset of sentinel diseases. The data infrastructure generated from this project will be made available to the research community and will be useful for a variety of aging-related research questions.

项目概要 相关性：大约四分之一的美国成年人患有多种疾病，或者同时患有两种或多种疾病 患有多种疾病的人会经历更多的残疾和更高的死亡风险。 我们对慢性病的发病和进展的了解比患有 1 种慢性病的人要高。 多重发病率是有限的 目标：制定临床实践指南和干预措施。 需要获得有关多种疾病进展、发病年龄和时间的准确信息， 以及不同人群之间的差异 目标： 1) 协调和弥合国家纵向数据。 追踪美国从 30 岁开始的慢性病和多种疾病的发病率。我们将结合 7 主要的国家成人健康队列数据集（Add Health、NLSY79、NLSY97、PSID、REGARDS、H-EPESE、 HRS）创建了一个从 30 岁开始的具有全国代表性的综合成年人队列，编制了超过 1.7 百万人年的随访，并包括相当数量的少数种族/族裔 2) 估计。 我们将确定从 30 岁开始的多发病率。 常见的慢性疾病群和与进展为较高风险相关的哨兵疾病 3) 制定针对美国成年人群的特定年龄多重发病风险的衡量标准 计算罹患多种疾病的终生风险以及罹患多种疾病的年数 4) 对于专业。 种族、性别、经济和地理群体，确定哨兵条件、年龄特定进展， 我们将估计不同群体之间的差异并量化其影响。 通过调整偏差的额外创新来减少无病预期寿命的这些差异 由于死亡率和住院治疗的差异，设计：将进行桥接和重新加权程序。 用于开发具有全国代表性的纵向出生队列的新数据基础设施， 我们将使用泊松回归来模拟多种发病率差异的年龄。 为了捕捉多重发病的顺序和节奏，我们将估计出现的概率。 对于患有 k 种既往慢性病的人，我们将估计正在经历一种额外的 (k+1) 种疾病。 基于 Kaplan-Meier 生存概率的累积概率将使用量化。 格林伍德估算器的影响：该项目将增进对性质、发作和影响的理解。 为了为临床实践和医疗保健指南提供信息，我们将确定多发病的进展。 考虑到发病年龄和哨兵疾病，转变为其他疾病的条件风险。 与政策的相关性，我们将模拟无疾病预期寿命的年数，这将通过 延迟或避免哨兵疾病发生的干预措施由此产生的数据基础设施。 该项目将提供给研究界，并将有助于各种与衰老相关的研究 研究问题。