Examining racial segregation and underlying mechanisms related to VCID and incident stroke in the REGARDS study

REGARDS 研究中检查种族隔离以及与 VCID 和中风事件相关的潜在机制

• 批准号: 10474231
• 负责人: NATALIE COLABIANCHI
• 金额: $ 225.82万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10474231
• 关键词: Address; Adult; Affect; Age; Ancillary Study; Area; Attention; Behavioral; Biological; Black American; Black Populations; Black race; Blood Vessels; Cardiovascular system; Cerebrovascular Trauma; Cerebrum; Child; Chronic Disease; Clinical; Cognitive; Communities; County; Crime; Data; Dementia; Development; Diabetes Mellitus; Discrimination; Disease; Educational Status; Enrollment; Etiology; Exposure to; Federal Government; Food; Geography; Goals; Health; Health behavior; Healthcare; Hypertension; Impaired cognition; Individual; Inequality; Institutes; Institution; Intervention; Investments; Legal; Life; Life Cycle Stages; Link; Local Government; Location; Long-Term Effects; Longitudinal cohort; Measures; Mediating; Mediator of activation protein; Neighborhoods; Neurologic; Not Hispanic or Latino; Outcome; Parents; Participant; Pathway interactions; Persons; Physical activity; Plant Roots; Policies; Population Study; Privatization; Public Health; Race; Reasons for Geographic And Racial Differences in Stroke; Research; Resources; Risk; Risk Factors; Role; Sampling; Schools; Shapes; Social Environment; Social Network; Social Policies; Social Work; Social support; State Government; Stroke; Stroke Belt; Structural Racism; United States; United States National Institutes of Health; base; black/white disparity; built environment; cerebrovascular; cohort; cost effective; experience; health inequalities; neuropathology; perceived discrimination; programs; prospective; racial disparity; residence; residential segregation; resilience; school district; segregation; social cohesion; social culture; social engagement; spatial epidemiology; stroke risk; vascular cognitive impairment and dementia; virtual

Racial inequity in the development of neurological conditions as people age is a major public health issue. While many individual risk factors have been identified as predictors of both vascular contributions to cognitive impairment and dementia (VCID), as well as stroke, these individual factors do not fully explain the stark Black- White disparities existing in these outcomes. Moreover, the structural mechanisms shaping these outcomes are far less understood; in particular, the racially unequal socio-environmental contexts that limit opportunities and resources based on race. Race-based school segregation and racial residential segregation (RRS) are two, critical, structural racism and discrimination (SRD) factors of hypothesized importance in how SRD contributes to inequalities in VCID and stroke, yet few studies exist in this area. At the intersection of chronic disease, life course, and spatial epidemiology emerges a unique opportunity to address this critical gap. This study leverages an ongoing, large-scale, population-based study: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study. REGARDS is a national sample of over 30,000 adults (45 years and older) with oversamples of persons self-identifying as non-Hispanic Black and people living in the stroke belt. The proposed study takes advantage of the longitudinal assessments of both VCID and stroke in this diverse cohort, and several other retrospective and prospective data related to biological, clinical (e.g., vascular health conditions), behavioral (e.g., health behaviors), socio-cultural (e.g., social support, social cohesion, perceived discrimination, social networks), and built and social environment (BSE) factors across multiple levels of influence (individual, interpersonal, community, and societal) collected through the parent study and two ancillary studies. These data include state-based and school-level school segregation measures for each school participants attended; objective, county-level educational quality measures for each year of schooling; historical participant residences that will be used to create a life course RRS exposure (median of 51 years) in the proposed study; and 9 BSE measures (food retail, parks, crime, commercial physical activity, healthcare, neighborhood SES, places of worship, social engagement, and social service institutions) for over 40,000 geocoded locations in middle and older ages that will be expanded upon in the proposed study via additional locations and years of data. The proposed study aims to: 1) Determine the association between school segregation on incident VCID and incident stroke later in life; the potential mediating role of educational quality; and to examine moderation by race, 2) Examine the association of RRS over the life course on incident VCID and incident stroke; and to examine moderation by race, and 3) Explore features of the residential neighborhood and interpersonal factors that may mediate the link between RRS in middle and older ages and incident VCID and stroke; and to examine moderation by race. This state-of-the-art study will identify pathways through which SRD contributes to VCID and stroke, the protective resilience factors, and points of intervention.

随着年龄的增长，神经系统状况发展的种族不平等是一个主要的公共卫生问题。 虽然许多单个危险因素已被确定为两种血管贡献的预测因素 障碍和痴呆（VCID）以及中风，这些个体因素无法完全解释鲜明的黑人 这些结果中存在的白色差异。此外，结构机制塑造了这些结果 不那么理解；特别是，种族不平等的社会环境环境限制了机会 和基于种族的资源。基于种族的学校隔离和种族住宅隔离（RRS）是 两个，批判性的，结构性的种族主义和歧视（SRD）因子在SRD中的重要性 导致VCID和中风的不平等，但在该领域很少有研究。在慢性的交叉点 疾病，生命过程和空间流行病学成为解决这一关键差距的独特机会。这 研究利用了一项持续的大规模，基于人群的研究：地理和种族的原因 中风的差异（有关）研究。问候是全国30,000多名成年人的样本（45年和 年龄较大）的人的示例是自我识别的非西班牙裔黑人和居住在中风带的人。 拟议的研究利用了这种多样的VCID和中风的纵向评估 队列，以及与生物学，临床有关的其他一些回顾性和前瞻性数据（例如，血管健康 条件），行为（例如，健康行为），社会文化（例如社会支持，社会凝聚力，感知到 歧视，社交网络）以及建立和社交环境（BSE）因素多个层次的因素 通过父母研究收集的影响力（个人，人际，社区和社会）和两个 辅助研究。这些数据包括为州基于州和学校级的学校隔离措施 学校参与者参加了；每年教育的目标，县级教育质量措施； 历史参与者住宅将用于创建生命课程RRS的暴露（中位数为51年） 拟议的研究；和9个BSE措施（食品零售，公园，犯罪，商业体育锻炼，医疗保健， 超过40,000的社区SES，礼拜场所，社会参与和社会服务机构） 在拟议的研究中将通过额外 位置和多年数据。拟议的研究旨在：1）确定学校之间的关联 生命后期的事件和事件中风的隔离；教育质量的潜在中介作用； 2）检查RRS在生命课程中有关事件VCID的关系的关联 和事件中风；并通过种族进行节制，3）探索住宅的特征 社区和人际关系因素可能介导中和年龄较大的RR之间的联系 事件VCID和中风；并通过种族进行节制。这项最先进的研究将确定途径 SRD会导致VCID和中风，保护弹性因素以及干预点。