Diversity Supplement to Using a Natural Experiment to Evaluate the Long-Term Effects of Neighborhood Deprivation on Alzheimer's Disease and Vascular Risk Factors

使用自然实验评估邻里剥夺对阿尔茨海默病和血管危险因素的长期影响的多样性补充

• 批准号: 10368376
• 负责人: Rita Hamad
• 金额: $ 6.11万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10368376
• 关键词: Address; Affect; Age; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Attention; Biological Factors; Birth; Blood Vessels; Characteristics; Cities; Clinical; Communities; Community Developments; Complex; Country; Crowding; Data; Data Sources; Denmark; Development; Diabetes Mellitus; Diagnosis; Disadvantaged; Discrimination; Environmental Risk Factor; Exposure to; Family; Future; Gender; Goals; Government; Health; Hyperlipidemia; Hypertension; Immigrant; Impaired cognition; Incidence; Individual; International Classification of Disease Codes; Intervention; Life; Life Cycle Stages; Life Experience; Link; Literature; Logistics; Long-Term Effects; Measures; Methodology; Minority Groups; Natural experiment; Neighborhoods; Observational Study; Outcome; Outcomes Research; Pathway interactions; Pattern; Policies; Population; Poverty; Quasi-experiment; Race; Randomized; Refugees; Research; Risk; Risk Factors; Sample Size; Sampling; Schools; Social Sciences; Socialization; Stroke; Subgroup; Techniques; Testing; Time; Violence; Vulnerable Populations; Work; base; clinical development; clinical encounter; cognitive function; cohort; dementia risk; deprivation; diabetes risk; environmental enrichment for laboratory animals; ethnic minority population; evidence base; follow-up; forest; high risk; indexing; innovation; machine learning method; member; mortality; parent grant; prevent; programs; protective factors; racial and ethnic; racial diversity; racial minority; residence; response; social; social factors; sociodemographics; socioeconomic disadvantage; socioeconomics; stressor; theories; therapy development; treatment effect; vascular risk factor; young adult

ABSTRACT The NIA has called for social science and community-based studies to clarify risk and protective factors for Alzheimer’s disease and related dementias (ADRD), particularly among racial minorities who are disproportionately affected. Place, including both neighborhood of residence and region/state of birth, has consistently been correlated with ADRD, stroke, and impaired cognitive function. Yet it is unclear whether modifiable mechanisms explain this association, or whether the association is merely due to the selection of unhealthy individuals into poor regions. The goal of this study is to produce the first quasi-experimental evidence to understand the influence of neighborhood socioeconomic deprivation on ADRD and its vascular risk factors. We take advantage of a unique natural experiment, overcoming methodological challenges in the previous literature on neighborhood effects on ADRD. From 1986 to 1998, the Danish government actively dispersed roughly 76,000 incoming refugees across the country in a nearly randomized (“quasi-random”) fashion to avoid over-crowding in major cities. This cohort includes nearly 12,000 individuals who lived until at least age 60 in Denmark during the 30-year follow-up. Over 90% of families agreed to participate in the program, creating a natural experiment in which these individuals were quasi-randomly assigned to neighborhoods with different levels of deprivation. We will employ unique data spanning over 30 years from Denmark’s population and clinical registers, which provide data on sociodemographics, clinical encounters, and prescriptions for all Danish residents. We identify cases of ADRD and its vascular risk factors among this racially diverse cohort via validated techniques using ICD codes and prescription data in clinical registers. We have successfully linked these registers to detailed geocoded data sources on eight measures of neighborhood socioeconomic deprivation. In Aim 1, our goal is to test the hypothesis that neighborhood deprivation increases the incidence of ADRD and mortality later in life. In Aim 2, we will examine the effects of neighborhood deprivation on vascular risk factors for ADRD, including highly prevalent conditions that occur across the life course. In Aim 3, we will identify vulnerable subgroups whose development of ADRD and vascular risk factors differs in response to neighborhood deprivation, taking advantage of the large sample size and complete register data available on all subjects. We will employ both hypothesis-driven and hypothesis- generating statistical techniques, including innovative machine learning methods that allow for more complex and robust subgroup identification. This will enable future interventions to be tailored to the most vulnerable individuals. Overall, the expected outcome of this research is to produce rigorous evidence on the effects of neighborhood characteristics on ADRD and vascular risk factors, overcoming the methodological challenges in previous work. This will directly inform the development of clinical, community, and policy strategies to address the neighborhood determinants of ADRD among vulnerable populations who are most at-risk.

抽象的 NIA呼吁进行社会科学和社区研究，以澄清风险和保护因素 阿尔茨海默氏病和相关痴呆症（ADRD），尤其是在少数民族中 受到不成比例的影响。地方，包括居住地和地区/出生地的地方 始终与ADRD，中风和认知功能受损相关。但是目前尚不清楚是否 可修改的机制解释了这种关联，或者是否仅仅是由于选择 不健康的人进入贫困地区。这项研究的目的是生产第一个准实验 了解邻里社会经济剥夺对ADRD及其血管的影响的证据 风险因素。我们利用独特的自然实验，克服了方法论挑战 以前关于邻里对ADRD的影响的文献。从1986年到1998年，丹麦政府积极积极 在一个几乎随机的国家中，全国大约有76,000名进入难民（“ Quasi-random”） 避免主要城市过度拥挤的时尚。这个队列包括近12,000名直到现在的人 在30年的随访期间，丹麦至少60岁。超过90％的家庭同意参加 程序，创建一个自然实验，其中这些人被准随机分配给 剥夺水平不同的社区。我们将采用超过30年的独特数据 丹麦的人口和临床记录提供了有关社会数字，临床相遇的数据， 和所有丹麦居民的处方。我们确定了ADRD及其血管危险因素的案例 通过临床记录中的ICD代码和处方数据，通过经过验证的技术在种族上多样化的队列。我们 已成功将这些寄存器与八个措施的详细地理编码数据源联系起来 邻里社会经济剥夺。在AIM 1中，我们的目标是检验邻里的假设 剥夺增加了生命之后的ADRD和死亡率的事件。在AIM 2中，我们将研究 ADRD血管危险因素的邻里剥夺，包括发生的高度普遍情况 在整个生活过程中。在AIM 3中，我们将确定弱势子群体的发展和 血管危险因素因邻里剥夺而有所不同，利用大型样本量 并完成所有主题上可用的注册数据。我们将采用假设驱动和假设 - 生成统计技术，包括创新的机器学习方法，允许更复杂 和强大的亚组识别。这将使将来的干预措施量身定制为最脆弱的 个人。总体而言，这项研究的预期结果是为有关 关于ADRD和血管危险因素的邻里特征，克服了方法论挑战 以前的工作。这将直接告知临床，社区和政策策略以解决 邻里确定最高风险的弱势群体中的ADRD。