This interdisciplinary study aims to identify biological, social, economic, and environmental influences on trajectories of health and functional outcomes in women in the transitional years from middle to later adulthood. It seeks to identify early adulthood experiences and exposures that affect (1) physical health, including body composition;blood pressure, biomarkers of inflammation and immune response to vaccination, dysregulation of glucose metabolism, and dyslipidemia;(2) physical functioning and disability;(3) cognition;and (4) psychosocial aspects of well-being including quality of relationships and depression. Data come from the ongoing, community-based Cebu Longitudinal Health and Nutrition Survey (CLHNS). The CLHNS has followed women through multiple survey rounds since 1983. With the proposed two additional survey rounds, the data will span a 30-year period of adult life, with a sample size of about 1875. Participants live in Metro Cebu, Philippines, in a changing environment characterized by rapid urbanization, social change, and economic development, providing an ideal setting in which to study how such changes influence health and functional capacity over time. At present 54% of women are 50-60 and 18% are >60 years old. Initial analysis will identify the sequence of development and patterns of co-occurrence of morbidity and disability risk. Subsequent multilevel longitudinal analysis will model the time-varying effects of the physical environment, including urbanization and its components of sanitation, air quality, crowding, housing density;socioeconomic status represented by wealth, income and education;family structure and relations with a focus on grandparenting roles;multiple dimensions of work related to its physical and time demands as well as work roles related to status and autonomy;as well as diet quality and physical activity. These exposures were selected because of their substantive importance, strong policy significance, and availability of especially detailed, high quality longitudinal data from the CLHNS. The study has the important advantage of having baseline data collected prior to the development of aging-related disease and disability, and will be able to identify causal associations.
The study of aging is particularly important in low- and middle-income countries, where dramatically changing social, environmental, demographic and morbidity patterns are resulting in an increased number of elderly surviving to older ages with more disabilities affecting their health care needs and quality of life. The proposed research will identify multiple environmental and lifestyle factors that accumulate over time to influence aging- related chronic diseases, disability and psychological health. It will provide the evidence needed to will inform care practices that may help women to maintain health and functional capacity, and improve their quality of life and reduce health care costs.