Structural Racism, Resilience, and Premature Cognitive Aging in End-stage Renal Disease

终末期肾病中的结构性种族主义、复原力和过早认知衰老

• 批准号: 10471530
• 负责人: Mara A. McAdams DeMarco
• 金额: $ 85万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-15 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10471530
• 关键词: Accounting; Address; Adult; Age; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Award; Behavioral; Biological; Black race; Chronic Disease; Cognition; Cognitive aging; Cohort Studies; Collaborations; Communities; Data; Data Set; Databases; Dependence; Diagnosis; Dialysis procedure; Discrimination; Elderly; End stage renal failure; Enrollment; Family; Foundations; Funding; Glean; Goals; Health Disparities Research; Impaired cognition; Individual; Institutional Racism; Intervention; Kidney; Link; Longevity; Measurement; Measures; Mediation; Medicare; Mental Health; Methods; Modeling; National Institute on Aging; Outcome; Participant; Patient Self-Report; Patients; Phase; Policies; Population; Prospective cohort study; Race; Registries; Risk; Source; Structural Racism; Suggestion; Survival Analysis; Testing; aged; base; black patient; cognitive function; comorbidity; demographics; design; experience; health disparity; health equity; improved; instrument; lifetime risk; perceived stress; premature; prevent; racial difference; racism; resilience

ABSTRACT Only 13% of the 780,000 adults living with end-stage renal disease (ESRD) have normal cognitive function. We found that 14.0% of ESRD patients aged 35-49 experience severe cognitive impairment and 2.9% have a co- occurring functional dependence suggestive of Alzheimer’s disease and related dementia (AD/ADRD). After dialysis initiation older (≥65) patients experience a 21-25% lifetime risk of AD/ADRD. Younger ESRD patients experience premature cognitive aging requiring the study of cognition and AD/ADRD across the lifespan. Black ESRD patients are more than twice as likely to develop cognitive impairment and 70%-78% more likely to be diagnosed with AD/ADRD; this disparity is comparable to a 10 year increase in age. While systemic racism is a known contributor to health disparities in community-dwelling older adults, its impact on cognitive aging among ESRD patients is understudied. Measurement of systemic racism (i.e., structural, institutional, and interpersonal) is crucial to identifying ESRD patients who are at risk of premature cognitive aging and those who are resilient in the face of racism. Elucidating mechanisms by which systemic racism impacts cognitive aging will lead to interventions and policies that may prevent the devastation of AD/ADRD for 234,000 Black ESRD patients. We seek to address a National Institute on Aging (NIA) goal (RFA-MD-21-004): “To elucidate whether and how mechanisms connecting structural racism to aging-relevant outcomes, including cognition and AD/ADRD, operate on multiple levels.” ESRD patients are the ideal population to elucidate these mechanisms: 1) 30% of patients are Black; 2) 87% experience premature cognitive aging; 3) all enroll in a national registry and 65% in Medicare for measurement of institutional racism. For all adult ESRD patients in the national registry/Medicare database, we will glean 23 indicators of structural racism from publicly available data and identify 3 indicators of institutional racism. Then, we will link these data to our ongoing, NIA-funded, multi-center, prospective cohort study (FAIR, n=5,275) of aging and ESRD to fully characterize systemic racism (lifecourse structural racism, institutional racism, and interpersonal racism). This is the oldest (>12 years) ESRD cohort study that includes longitudinal measures global and domain specific cognitive function. The National Kidney Foundation, Alzheimer’s Association, and a local community advisory board will guide the design and interpretation of the following aims: 1) To estimate the impact of structural and institutional racism on incident AD/ADRD; 2) To quantify the contributions of lifecourse systemic racism on cognitive impairment and decline; and 3) To test whether resilience to systemic racism protects against cognitive impairment and decline. By taking a lifecourse approach and engaging community, family, and patient stakeholders in all phases of our study, we will identify feasible targets for improving resilience in the face of systemic racism. These potential targets for interventions and policies to counter structural racism will likely generalize to other populations with chronic diseases.

抽象的 在 780,000 名患有终末期肾病 (ESRD) 的成年人中，只有 13% 的认知功能正常。 研究发现，35-49 岁的 ESRD 患者中有 14.0% 患有严重认知障碍，2.9% 患有合并症 功能依赖提示阿尔茨海默病和相关痴呆 (AD/ADRD)。 开始透析的老年（≥65 岁）患者终生患 AD/ADRD 的风险为 21-25%。 经历过早的认知老化，需要在整个生命周期中研究认知和 AD/ADRD。 ESRD 患者出现认知障碍的可能性是其两倍多，并且出现认知障碍的可能性高出 70%-78% 被诊断患有 AD/ADRD 的人；这种差异相当于年龄的增长 10 岁，而系统性种族主义是一个问题。 已知导致社区老年人健康差异的因素，其对认知老化的影响 ESRD 患者的系统性种族主义（即结构性、制度性和种族歧视）的测量尚未得到充分研究。 人际交往）对于识别有认知早衰风险的 ESRD 患者以及那些 阐明系统性种族主义影响认知的机制。 老龄化将导致干预措施和政策的实施，可能会防止 234,000 名黑人遭受 AD/ADRD 的破坏 我们寻求实现国家老龄化研究所 (NIA) 的目标 (RFA-MD-21-004)：“阐明 是否以及如何将结构性种族主义与老龄化相关结果（包括认知）联系起来的机制 和 AD/ADRD，在多个层面上进行操作。”ESRD 患者是阐明这些的理想人群。 机制：1) 30% 的患者是黑人；2) 87% 的患者经历过早的认知老化；3) 全部参加了 国家登记处和 65% 的医疗保险用于衡量机构种族主义。 国家登记/医疗保险数据库，我们将从公开数据中收集 23 项结构性种族主义指标 然后，我们将这些数据与我们正在进行的、NIA 资助的、 关于衰老和 ESRD 的多中心前瞻性队列研究（FAIR，n=5,275），以全面描述系统特征 种族主义（生命历程结构性种族主义、制度性种族主义和人际种族主义）这是最古老的（>12）。 年）ESRD 队列研究，包括纵向测量全局和特定领域的认知功能。 国家肾脏基金会、阿尔茨海默病协会和当地社区咨询委员会将指导 设计和解释以下目标： 1）评估结构性和制度性种族主义的影响 2) 量化生命全程系统性种族主义对认知障碍的影响 和下降；以及 3) 测试对系统性种族主义的抵抗力是否可以防止认知障碍和 通过采取生命全程方法并让社区、家庭和患者利益相关者参与其中。 在我们研究的各个阶段，我们将确定提高面对系统性种族主义的复原力的可行目标。 这些对抗结构性种族主义的干预措施和政策的潜在目标可能会推广到其他目标 患有慢性病的人群。