Cells and Surveys Should Biological Measures Be Included in Social Science Research? (2001) / Chapter Skim
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Integrating Biology into Demographic Research on Health and Aging (With a Focus on the MacArthur Study of Successful Aging)
Integrating Biology into Demographic Research on Health and Aging (With a Focus on the MacArthur Study of Successful Aging)
Pages 9-41
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From page 9... ...
Such development would both specify the way that traditional demographic factors operate and point to places for intervention. Inclusion of the collection of biological data in representative surveys will be required to link population health outcomes to individual social, economic, and psychological characteristics and better understand and address the policy issues linked to questions about trends and differentials in population health.
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From page 10... ...
The third section of the chapter introduces the details of biological data collection for the MacArthur Study. This study is an example of a completed, multiple-community study in the United States with extensive biological information of the type which can be useful in augmenting current demographic approaches toward health in aging populations.
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From page 11... ...
The inclusion of bioindicators in demographic models of health outcomes adds an additional level of mechanisms through which traditional socio-demographic variables affect health outcomes. Inclusion of a set of biological proximate determinants in models of health outcomes among the older population represents a model expansion similar to that occurring over the last two decades in demographic models of fertility or of child health (Bongaarts, 1978; Mosley and Chen, 1984~.
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From page 12... ...
In an older population where health status has been achieved over a life span, the study of health change is particularly important in identifying current health processes and the relationship of independent variables to outcomes. Information on most of the health outcomes identified in Figure 2-1, other than mortality, is usually collected in population surveys through self or proxy report; however, performance testing of mental functioning has been incorporated in recent national surveys (Herzog and Wallace, 1997)
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From page 13... ...
. 1 1 Health Behaviors Diet Exercise Smoking Drinking Social Psychological Characteristics Social Support Personality Characteristics Life Circumstances Stress Control Job Characteristics Health Care Availability and Use of Treatment and Medications Source of Payment Use of Preventative Care Biological Mechanisms Hypertension Cholesterol Height-weight Body Mass Index Childhood diseases Stiffness of joints Shortness of breath Balance problems Health Outcomes Mortality Disability Functional Loss Diseases, Conditions Impairment FIGURE 2-2 Model of health outcomes employed with contemporary demographic surveys.
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From page 14... ...
Bioindicators in the Demographic Approach The demographic approach to health analysis currently includes some indicators of "biology" which can be thought of as either biological risk factors for the onset of disease, precursors of disease outcomes, or additional biological outcomes. The development of models clearly specifying the role of biological factors in determining health outcomes in old age has been less formal than in other areas of demographic research.
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From page 15... ...
Currently employed biological indicators have usually been indicators of increased risk for poor health outcomes. For instance, the presence of high cholesterol and hypertension are generally asked in current surveys, reflecting the increase in both professional and informant knowledge of these health indicators as risk factors for poor health outcomes.
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From page 16... ...
We need to clarify how this occurs. There is a significant body of research linking demographic variables to biological indicators and bioindicators to health outcomes important in aging populations that will allow the development of a set of biological proximate determinants of health outcomes relevant to older populations.
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From page 17... ...
For instance, many persons who are currently using medication still have elevated measured blood pressure, while some who have been hypertensive in the past measure as normotensive even though they are not under treatment. THE INCORPORATION OF ADDITIONAL BIOLOGICAL INDICATORS Biological indicators can appropriately be included in demographic analysis if they represent biological states that are reasonably prevalent in the general population and states that have been linked both to major population health outcomes and to demographic, social, or psychological mechanisms affecting health outcomes.
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From page 18... ...
Incorporation of information on this genetic indicator could lead to increased knowledge of the interactive mechanisms of this genetic marker and other social and behavioral variables and thus clarify some of the mechanisms leading to population differentials in cognition, heart disease, and mortality. We suggest that other bioindicators appropriate for current demographic surveys include those that represent the physiological status of major regulatory systems and processes through which demographic, social, psychological, and behavioral variables work to affect health.
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From page 19... ...
Higher total serum cholesterol and higher relative weight have been shown to be risk factors for poor health outcomes including mortality, cardiovascular disease, and functioning loss and to be related to race, sex, age, and SES (Adler et al., 1994; Benfante et al., 1985; Bucher and Ragland, 1995; Kaplan and Keil, 1993; Lynch et al., 1996; Marmot et al., 1997; Winkleby et al., 1992~. While information has been gathered in surveys on the presence of high total cholesterol, recent medical practice emphasizes the importance of knowing the components of cholesterol high density (HDL)
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From page 20... ...
Measurement of the components of cholesterol could be productively included in population studies where blood samples are drawn. Comparison of total levels of cholesterol and levels of high density cholesterol in the MacArthur study indicates that using an indicator of total cholesterol or one of high-density cholesterol will stratify the population differently according to risk.
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From page 21... ...
, and to poorer cognitive function (Craft et al., 1993; Gradman et al., 1993; Manning et al., 1990; Reaven et al., l990~. Analyses using the MacArthur data have shown that functional decline in older persons is related to a history of diabetes and poorer glucose metabolism (Seeman et al., 1994b)
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From page 22... ...
These markers have proven to be relatively strong risk factors for major health outcomes. In fact, high levels of CRP appear to increase the risk for cardiovascular disease as much as adverse levels of HDL cholesterol (de la Serna, 1994; Kannel et al., 1987; Ridker et al., 1997~.
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, poorer cognitive functioning (Lupien et al., 1994; Seeman et al., 1997a) , and increased risks for fractures (Greendale et al., 1999~.
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From page 24... ...
and has been shown to be related to both five-year mortality and SES within older populations (Cook et al., 1989, 1991~. Reduced lung function is likely to be more common among those of lower SES and those with poor health behaviors.
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Parameters included in initial measures of allostatic load included: systolic and diastolic blood pressure, waist-hip ratio, serum HDL and total cholesterol, blood plasma levels of glycosylated hemoglobin, DHEAS, 12-hour urinary cortisol excretion, and 12-hour urinary norepinephrine and epinephrine excretion levels. The summary measure of allostatic load was also shown to be a significantly better predictor of outcomes than the individual component factors, providing evidence that risk for these outcomes is related to the overall impact of dysregulation across the various regulatory systems.
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From page 26... ...
. COLLECTION OF BIOLOGICAL INFORMATION IN THE MacARTHUR STUDY Many of the findings cited above have been derived from or replicated in the MacArthur Study of Successful Aging with which Seeman has long been associated (see Rowe and Kahn, 1998, for an overview)
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From page 27... ...
While all of the studies listed above provide important background relevant to the inclusion of bioindicators in demographic surveys, we describe the home-based data collection procedures used in the MacArthur study. The MacArthur Study of Successful Aging is a threesite longitudinal study of 1,189 persons aged 70-79 years at baseline.
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From page 28... ...
Biomedical Assessments While most population surveys get self-reports on some biological indicators, the MacArthur study included measurement of seated and postural blood pressure, pulmonary function, and waist/hip ratio as part of the biomedical protocol. Systolic and diastolic pressures were calculated as the average of three readings (Hypertension Detection and Follow-up Program Cooperative Group, 1978~.
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From page 29... ...
The sera were then sent to Nichols Laboratories for standard assessments including a CBC and an SMAC and measurements of HDL and total cholesterol, dehydroepiandrosterone sulfate (DHEAS) , and serum glutamic-oxaloacetic transaminase (SGOT)
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From page 30... ...
The value of population surveys addressing health issues will increase markedly when additional biological information is collected which can be used to clarify how demographic factors get under the skin to produce health outcomes. As outlined above, studies such as the MacArthur Study of Successful Aging, which have included demographic information along with infor
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From page 31... ...
There are strong relationships between all of the biological parameters described and what are usually considered demographic variables. There are also relationships between the major health outcomes of interest in aging populations and these biological indicators.
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From page 32... ...
Ragland 1995 Socioeconomic indicators and mortality from coronary heart disease and cancer: A 22 year follow-up of middle-aged men. American Journal of Public Health 85:12311236.
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1989 Peak expiratory flow rate in an elderly population. American Journal of Epidemiology 130:66-78.
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Gardin 1998 Risk factors for 5-year mortality in older adults: The Cardiovascular Health Study. Journal of American Medical Association 279:585-592.
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From page 35... ...
Riggs 1995 B vitamins as risk factors for age-related diseases. In Nutritional Assessment of Elderly Populations: Measure and Function, I.H.
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From page 36... ...
Tracy 1991 The relation between serum albumin levels and risk of coronary heart disease in the Multiple Risk Factor Intervention Trial. American Journal of Epidemiology 134:1266-1277.
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Tuomilehto, and J Salonen 1996 Do cardiovascular risk factors explain the relation between socioeconomic status and risk of all-cause mortality, cardiovascular mortality, and acute myocardial infarction?
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From page 38... ...
Molineaux 1995 Association of helicobacter pylori and chlamydia pneumonia infections with coronary heart disease and cardiovascular risk factors. British Medical Journal 311:711714.
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From page 39... ...
Talvi, and T Seeman 2000b High urinary catecholamine excretion predicts mortality and functional decline in high functioning community-dwelling older persons: MacArthur Studies of Successful Aging (submitted)
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From page 40... ...
Savage, and the Cardiovascular Health Study investigators 1995 Fibrinogen and Factor VIII, but not Factor VII, are associated with measures of subclinical cardiovascular disease in the elderly: Results from the Cardiovascular Health Study. Arteriosclerosis, Thrombosis and Vascular Biology 15:1269-1279.
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From page 41... ...
Frank, and S Fortmann 1992 Socioeconomic status and health: How education, income and occupation contribute to risk factors for cardiovascular disease.
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