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.

项目摘要 相关性：大约四分之一的美国成年人患有多个多发病或两个或更多并发 慢性疾病。具有多种多发病的人会经历更多的残疾和更高的死亡风险，并具有 比患有1个慢性病的人高的医疗费用更高。我们对开始和发展的理解 多种病是有限的。目标：制定临床实践指南和干预措施，是 必须获得有关多种多发性进展的准确信息，发作的年龄和时机， 以及这些人群之间的差异。目的：1）协调和桥接国家纵向数据 跟踪美国从30岁开始的美国慢性疾病和多种病的发病率。我们将结合7 总理国家人群成人健康数据集（Aff Health，NLSY79，NLSY97，PSID，邮票，H- EPESE， HRS）创建一个从30岁开始的全国代表性的成年人群体，以超过1.7的成绩 随访的百万人年，包括大量的种族/族裔少数民族。 2）估计 从30岁开始的多发性疾病发展。我们将确定特定年龄的进度率 常见的慢性疾病簇和前哨状况与较高的进展风险相关 其他疾病。 3）制定针对美国成年人口的多个年龄特异性风险的衡量标准 计算发展多种病的寿命风险和多发性多发性的数年。 4）专业 种族族裔，性别，经济和地理群体，确定哨兵条件，特定年龄的进步， 和终身的多种危险。我们将估计各组之间的差异，并量化 通过调整偏见的额外创新，减少了有关无疾病预期寿命的这些分布 由于死亡率不同和制度化。设计：桥接和重新持续程序将是 应用于使用全国代表性纵向出生队列和 合成队列。我们将使用泊松回归来建模多种多元化差异的年龄 出现。为了捕获多个多发病的测序和起搏，我们将估计 对于患有K先验慢性疾病的患者，经历了额外的（K+1）。我们将估计 基于Kaplan-Meier生存可能性的累积可能性。差距将使用 格林伍德的估计器。影响：该项目将提高对性质，发作和发作的理解 多种多发性的进展。为了告知临床实践和医疗保健指南，我们将确定 给定发病年龄和前哨疾病的有条件过渡到其他疾病的风险。特别 与政策相关，我们将模拟多年的无病预期寿命 延迟或避免哨兵疾病发作的干预措施。从此生成的数据基础架构 项目将提供给研究社区，对于各种与衰老有关的项目非常有用 研究问题。