The Center on the Demography and Economics of Aging (CoA) at the University of Chicago has four priority research areas: (1) family living arrangements, (2) race, ethnicity, socioeconomic status and the social context; (3) biodemography of aging, (4) health and medicine.

Social Relationships, Living Arrangements, and Family

Individuals live in many overlapping social worlds. The most immediate of these is the household – the collectivity formed by persons sharing a dwelling. In middle through early old ages, people live in quite diverse households. A sizeable minority of older persons lives alone. Epidemiological and prospective studies have identified social isolation as a major risk factor for psychological disturbances and for broad-based morbidity and mortality, but the behavioral, psychological, and biological mechanisms responsible for the epidemiological relationship between social isolation and health are not well understood.

Several past and active projects at the Center focus on social relationships, living arrangements, and family:

• John Cacioppo’s Program Project, Social Isolation, Loneliness, Health and the Aging Process, which was completed in August 2008, comprised three projects, each focused on a different level of the process through which loneliness and social isolation are produced and through which they affect health among older adults.
• The National Social Life, Health, and Aging Project (NSHAP), explores health and well-being in American men and women age 57 to 85. The centerpiece of the project is a longitudinal, nationally representative in-home survey of 3005 non-institutionalized people first interviewed in 2005-2006 and interviewed a second time in 2010-2011. It describes, for the first time, distributions of physical and psychocognitive health, illness, medication use, and sexuality among older adults. The study employs cutting edge biomeasures including: height, weight, blood pressure, serum (glucose metabolism, immune function, inflammation), vaginal swabs (HPV, bacterial vaginosis, chlamydia, trichomonas), saliva (endocrine evaluation, cotinine), actigraphy, and sensory testing. The project tests the general hypothesis that older adults with a well-functioning intimate and/or sexual relationship will show better physical and emotional health, and better health trajectories, than those who lack such a relationship.

Race, Ethnicity, Socioeconomic Status and the Social Context

This focus area at the Center includes the examinations of: association of health and socio-economic status; economic determinants of health promotion and disease prevention behaviors; understanding the mechanisms underlying these associations; variables of interest such as the effects of lifelong poverty, birth weight, access to and utilization of employer-provided health insurance, and circumstances of immigration; studies of the health of diverse racial and ethnic older populations and the health of small geographic areas; the changing composition and conceptualization of race and ethnicity in the US.

A long research tradition has focused on social characteristics, such as gender and race, as risk factors for health decline in old age. While much research has addressed this area, there are still gaps in basic knowledge of the demography of aging in some groups, in particular the relatively new and rapidly growing immigrant populations. Moreover, recent conceptualizations of the social processes surrounding health have emphasized the role of social environment in addition to individual demographic characteristics. These frameworks suggest that the development of health problems with age is critically dependent upon interactions between the individual and his or her social surroundings. The capacity of communities to bolster and sustain the well-being of individual residents is particularly salient for older adults; their daily activities are likely dependent on the infrastructure and social resources of their communities, particularly if health is already compromised.

Three projects at the Center are particularly illustrative of this research tradition at Chicago:

• The Union Army Project, formally titled Early Indicators of Later Work Levels, Disease, and Death, directed by Robert Fogel. The completed life-cycle Union Army data set is based on 35,570 men out of a randomly drawn sample of 39,616 males who were mustered into the Union Army from 1861 to 1865. Socioeconomic and biomedical histories of the recruits from childhood to death have been created by linking together information from different sources. This Program Project investigated the impact of socioeconomic and biomedical disparities during developmental, middle-life, and older ages on the onset of specific chronic diseases at middle and late ages, on the capacity to work during these ages, on the demand for retirement, and on waiting time to death from specific causes. The project bears on the explanation of the marked decline in US age-specific morbidity and mortality rates over the 20th century.
• Neighborhood Context and the Health of Older Adults, directed by Kate Cagney and funded by the NIA. This project brings an important new sociological concept, collective efficacy, to bear on the study of neighborhood and the health of older persons. The project addresses the following questions: 1) Are structural features of urban neighborhoods — concentrated poverty, concentrated affluence, residential stability, ethnic heterogeneity, and age structure — associated with the health status of older residents?; 2) Are neighborhood social processes — collective efficacy, social networks, social norms, and physical/social disorder — associated with the health of older residents?; 3) Is the health services infrastructure of the neighborhood associated with the health of older residents?; and 4) Does the health of older residents affect the ability of the community to sustain social networks and develop collective efficacy? This project combines perspectives from sociology and health services research; it bridges these disciplines to formulate research that addresses a set of questions vital to both fields and to aging-related health and social policy.
• An interdisciplinary study of early-onset breast cancer among African-Americans through the Centers for Population Health and Health Disparities in the Center for Interdisciplinary Health Disparities Research, co-directed by Martha McClintock. McClintock leads a project on the impact of social isolation on the expression of genes affecting mammary tumors in rats. Insights from this animal model will inform a test of the hypothesis that hypervigilance and social isolation in Black women of African ancestry increase their risk of early, lethal breast cancers. Black women suffer more early, aggressive, lethal breast cancers than do White women of Northern European ancestry.

Biodemography of Aging

The study of the psychological and physiological mechanisms that may underlie the strong associations between social and economic factors and health outcomes is an important new research area at the University of Chicago. Research in this area includes examinations of: biological mediators of the relationship between socio-economic status and health; demographic aspects of heritability and familial aggregation of disease and longevity; incorporation of genetic, biological, and disease variables into demographic models and age-specific mortality rates. Multidisciplinary teams are key to developing innovative projects in this area. The University of Chicago is well situated to carry out research in this area not only because of a strong interdisciplinary tradition but also quite simply because it is a compact urban campus, where demographers and social, biomedical and behavioral scientists are all within a few minutes of each other. These projects include state-of-the-art assessments in the lab of biobehavioral processes as well as biomarker data that can be collected in the home.

Three recent major NIA-funded efforts in this area at the Center, including two program projects and a national survey, are leading the way in the biodemography of aging:

• John Cacioppo’s program project Social Isolation, Loneliness, Health and the Aging Process included several biological measures of specific pre-disease pathways. These include cardiovascular measures (e.g. blood pressure, cholesterol, homocysteine, total peripheral resistance, and cardiac output), measures of pulmonary function, stress homones (e.g. urinary cortisol and catecholamines), immune function (e.g. EBV), and HPA activity (e.g. salivary cortisol).
• Eve Van Cauter’s program project Alterations of Circadian Timing in Sleep and Aging uses a multidisciplinary approach, combining epidemiology, clinical research, in vivo studies in laboratory rodents, and molecular genetic analyses to test whether chronic partial sleep loss has adverse effects on biomarkers of aging and increases the risk of obesity and diabetes. Project 1, led by Diane Lauderdale, is an epidemiologic project which adds in-home wrist actigraphy (a non-intrusive objective measurement of sleep duration and fragmentation) to an on-going NHLBI-funded cardiovascular cohort (CARDIA cohort participants at the Northwestern University site) to examine both the social and economic determinants of sleep quantity and also whether sleep quantity predicts weight gain and diabetic risk over the course of five years. Other projects in the program project carry out complimentary analyses in the sleep lab, intensively monitoring how controlled sleep duration affects appetite and metabolic function.
• NSHAP collects biomarkers and biomeasures of health and physiological functioning among 3005 participants aged 57 to 85 and their partners to better characterize the health of survey participants, as described in detail under Area 1 (Social Relationships, Living Arrangements and Family) above.

Health and Medicine

Scholars at the Center on Aging have a long history of research on health care systems: how health systems are organized and financed; delivery of medical care to older populations; factors underlying the recent trend in declining disability and causal factors underlying the trend (e.g. medical technological interventions, health care access and use, early life experiences) as well as the intervention to maintain and accelerate the trend. The organization, costs, and quality of medical care all influence health trajectories and health outcomes for the elderly. Public and private medical insurance are also key determinants of health for older persons. A number of economists at Chicago attempt to understand theoretically and measure empirically the larger institutional or market context.

• Marshall Chin’s projects Improving Diabetes Care Collaboratively in the Community and Outcomes, Incentives, and Improvements in Collaboratives seek to improve and evaluate the quality of chronic disease management for the indigent elderly served by federally funded health centers, and thus reduce health disparities.
• David Meltzer’s project A Multi-Center Trial of Academic Hospitalists measures and analyzes the effects of hospitalists (physicians specializing in inpatient care) on quality of care, costs, and medical education among the general medicine services of six academic medical centers.
• Naoko Muramatsu’s project State Long Term Care Policies and Elderly Well-Being investigates how trajectories of long term care use and well-being among elderly persons vary as a function of state level policies and across cohorts.
• David Meltzer and Elbert Huang's project on self-selection and cost-effectiveness in diabetes examines how patient choice in the context of heterogeneous preferences affects the cost-effectiveness of treatments for diabetes.
• Marshall Chin’s project Treatment Preferences of Older Patients with Diabetes assesses older patients' preferences regarding the aggressiveness of their diabetes treatment and determines the concordance between their preferences and physicians' preferences regarding the aggressiveness of diabetes care, as well as with actual treatment style.