Implications of residential location in midlife disability and cognitive functioning among the poor vs. rich: within the US and cross-country comparisons

居住地点对穷人与富人中年残疾和认知功能的影响：美国国内和跨国比较

• 批准号: 10583637
• 负责人: HwaJung Choi
• 金额: $ 61.5万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-15 至 2027-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10583637
• 关键词: Address; Adult; Affect; Age; Aging; Area; Characteristics; Childhood; Cognitive; Communities; Country; County; Data; Data Protection; Dementia; Disadvantaged; Economic Factors; Economics; England; Europe; European; Exposure to; Family; Geographic Factor; Geographic Locations; Geography; Goals; Health; Health Food; Health Policy; Health Status; Health Surveys; Health and Retirement Study; Healthcare; Healthcare Systems; Income; Individual; Inequality; Institution; Life; Life Cycle Stages; Life Expectancy; Link; Location; Longitudinal Studies; Marketing; Methods; Neighborhoods; Outcome; Policies; Population; Positioning Attribute; Procedures; Public Health; Quasi-experiment; Recording of previous events; Resources; Retirement; Risk; Role; Social Policies; Social Protection; Socioeconomic Status; Surveys; Variant; aged; built environment; cognitive function; comparative; contextual factors; data harmonization; disability; disability risk; disparity reduction; geographic difference; health data; health disparity; improved; intervention program; life history; low socioeconomic status; middle age; mortality; novel; peer; population health; programs; safety net; social; social vulnerability; socioeconomics; stressor; trend; walkability

PROJECT SUMMARY/ABSTRACT Despite that the US spends much more on healthcare than other high-income countries, the health and life expectancy of US working-age adults has declined, losing ground further to their peers in other countries. Identifying those most at risk for worsening health and determining the key factors contributing to the widening health disparities in the US population is critically important and timely. The overarching goal of this project is to clarify the multi-level factors in determining US midlife health, focusing on disability and cognitive functioning outcomes. We will first focus on within-US comparison determining the role of place-specific contextual factors in disability and cognitive functioning among working-age adults in the US. We will use a quasi- experimental approach to enhance detecting marginal effects attributable to place-level vs. individual- level factors; we compare adults with similar individual-level characteristics and resources but living in areas with different place-level contexts. We will examine contextual factors of multi-level geographic units such as tract-level social vulnerability and built environment, county-level social programs and resources, and state-level social protection and healthcare policy. We will also capitalize on life-history data that provide residential histories over the entire life course to help understate the level of exposure and differential effect by life stage. We will then identify factors contributing to the relative position of US midlife disability and cognitive functioning compared to other high-income European countries. We will use harmonized survey data from the Health and Retirement Study (HRS), English Longitudinal Study of Ageing (ELSA), and Survey of Health, Ageing and Retirement in Europe (SHARE). We will assess the extent to which national-level economic inequality, healthcare system, and social protection policies affected the relative position of the US among low- vs. high-SES adults. We will then examine the extent to which local-area factors contribute to the difference in the outcomes across countries by leveraging and extending the study team’s novel procedure to harmonize local-area contextual data across countries and link the contextual data to each survey. This study will contribute to clarifying socioeconomic, physical, and institutional factors for geographic variation in midlife health by intersecting multi-level contextual factors with individual-level socioeconomic characteristics. The project will also advance data for the comparative assessment in cross-country health disparity by generating the local-area data harmonized across high-income countries, which will be released in full compliance with confidential data protection policies. 1

项目概要/摘要 尽管美国在医疗保健方面的支出比其他高收入国家高得多，但健康和 美国劳动年龄成年人的预期寿命下降，进一步落后于其他国家的同龄人 确定健康状况恶化风险最大的国家并确定关键因素。 为美国人口日益扩大的健康差距做出贡献至关重要且及时。 该项目的总体目标是阐明决定美国中年健康的多层次因素， 关注残疾和认知功能结果。 我们将首先关注美国内部的比较，以确定特定地点的背景因素在 我们将使用准-美国工作年龄成年人的残疾和认知功能。 加强检测归因于地方水平与个人的边际效应的实验方法 水平因素；我们比较具有相似个人水平特征和资源但生活在 我们将研究多层次地理的背景因素。 诸如地区级社会脆弱性和建筑环境、县级社会计划和 我们还将利用生活史。 提供整个生命历程的居住历史的数据，以帮助低估暴露水平 以及不同生命阶段的不同影响。 然后，我们将确定导致美国中年残疾和认知能力相对地位的因素 与其他高收入欧洲国家相比，我们将使用统一的调查数据。 来自健康与退休研究 (HRS)、英国老龄化纵向研究 (ELSA) 和调查 我们将评估欧洲健康、老龄化和退休的程度。 经济不平等、医疗保健系统和社会保障政策影响了相对地位 然后我们将研究当地因素在多大程度上影响了美国的低SES 成年人和高SES 成年人。 通过利用和扩展研究来促进各国结果的差异 团队的新颖程序可以协调各国的当地背景数据并将 每个调查的背景数据。 这项研究将有助于澄清地理的社会经济、自然和制度因素 通过将多层次背景因素与个人水平相交叉来研究中年健康的变化 该项目还将提供用于比较评估的数据。 通过生成跨高收入地区协调的当地数据来消除跨国健康差异 国家，这些信息将完全遵守保密数据保护政策而发布。 1