Understanding Cross-National Health Differences at Older Ages and Their Causes This project aims to foster understanding of cross-national differences in health and their causes, especially evaluating differences in health care systems, coverage and quality, health behaviors, life styles, income and wealth distributions and historical life circumstances. Understanding differences and causes requires comparable measurements of health which do not suffer from cross-national differences in data collection and reporting styles. In this respect, analyses of blood samples are a gold standard of objective health measurement. The project will extend earlier blood-based health comparisons between the US (based on the Health and Retirement Study, HRS) and the UK (based on the English Longitudinal Study of Ageing, ELSA) to Continental Europe (based on the Survey of Health, Aging and Retirement in Europe, SHARE). SHARE is a large population-representative panel study modelled after the HRS and ELSA. Health variables strictly harmonized across the three studies include self-reported health, ADLs and IADLs, physical measurements such as grip strength, peak flow and chair stand, and a large battery of tests for cognition and mental health. SHARE has obtained very rich data on health care systems and life styles, on economic, work and social circumstances over the life course, and individual histories of health behaviors and health care interventions. SHARE has also collected dried blood spot samples (DBSS) from about 27.000 respondents aged 50 and older in 13 Continental European countries. HRS has also collected DBSS in recent waves. While DBSS are not perfect substitutes for the venous blood (VB) samples obtained by ELSA and currently by HRS, much progress has recently been made in understanding how values obtained from DBSS correspond to VB values. We have performed extensive validations which show a tight alignment between DBSS and VB values after correcting for systematic factors that occur during the laboratory and field processes. The project has four specific aims: 1. Capitalize upon the expertise of the laboratory at the University of Washington by having the full set of DBSS collected in SHARE wave 6 assayed for the lipid panel and type-2 diabetes mellitus (T2DM) biomarkers relevant to general health and cognitive decline. 2. Link the laboratory analyses with the SHARE functional and subjective health, demographic, social, and economic data, create a user-friendly database and archive it. 3. Harmonize the data obtained from the assays of SHARE DBS, ELSA VB and HRS DBS and VB. 4. Use these data to perform statistical analyses on the relationships between cross-national differences in health, economic, work and social circumstances, health behaviors and health care interventions.
The general aim of this project is to exploit the large international variations in health and life circumstances in the US and Europe to better understand the causes for these large differences. The project specifically analyzes health status as indicated by analyses of a very large set of blood samples collected from donors in 13 European countries and links that data to the large differences in socio- economic conditions and health care systems at the national level and, at the individual level, to bio- medical and socio-economic events over the life course.