A Binational Study to Understand Dementia Risk and Disparities of Mexican Americans: The Role of Migration and Social Determinants

一项了解墨西哥裔美国人痴呆症风险和差异的两国研究：移民和社会决定因素的作用

• 批准号: 9288547
• 负责人: Medellena Maria Glymour
• 金额: $ 36.35万
• 依托单位: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-06-15 至 2018-12-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9288547
• 关键词: Accounting; Acculturation; Acute; Adopted; Adult; Aging; Alzheimer' s disease risk; Automobile Driving; Back; Characteristics; Childhood; Chronic; Cognitive; Cognitive aging; Data; Data Set; Dementia; Disadvantaged; Discrimination; Education; Elderly; Environment; Epidemiology; Evaluation of Risk Factors; Exhibits; Goals; Health; Health and Retirement Study; Household; Immigrant; Immigration; Impaired cognition; Incidence; Individual; Infant Mortality; International Migrations; Latino; Link; Masks; Measures; Mexican; Mexican Americans; Mexico; Neighborhoods; Nomads; Older Population; Outcome; Participant; Pattern; Population; Poverty; Predictive Factor; Prevalence; Recording of previous events; Resources; Return Migrations; Risk; Risk Factors; Role; Sampling; Selection Bias; Social status; Socioeconomic Factors; Socioeconomic Status; Source; Testing; United States; Work; aged; base; cohort; ethnic minority population; experience; health disparity; higher education; improved; insight; low socioeconomic status; migration; mortality; neighborhood disadvantage; novel; novel strategies; racial and ethnic; racial and ethnic disparities; residence; social; socioeconomic disadvantage; socioeconomics; stressor

Summary Little is known about dementia disparities for Mexican Americans, who comprise the majority of United States (US) Latinos. Mexican Americans experience substantial social disadvantages compared with non-Latino whites in the US, including lower education, lower socioeconomic status, and migration-related stressors. Despite sustained disadvantage, the limited available evidence suggests that Mexican Americans exhibit similar rates of dementia as non-Latino whites. Unexpected health advantages of Mexican Americans have also been observed for many other health outcomes. Selective migration, both of healthy people from Mexico to the US and return migration of unhealthy adults back to Mexico, is a leading explanation for the Mexican American health advantage. Several known risk factors for dementia are also predictors of migration from Mexico to the US. However, no work has quantified selective migration and the bias it introduces to the comparison between Mexican American and non-Latino whites with respect to dementia risk. Therefore, it is unknown whether a dementia risk disparity exists for Mexican Americans after correcting for selective migration. In this study, we propose to combine data from two harmonized, nationally representative cohorts of adults aged 50+: the US Health and Retirement Study (HRS, n=26,690, including 2,452 Mexican Americans) and the Mexican Health and Aging Study (MHAS, n=13,798). These cohorts include harmonized longitudinal cognitive measures that are robustly linked to dementia risk. Accounting for selective migration is almost impossible with US-only data. Combining data from a Mexico- and a US- based cohort, we include both migrants and non-migrants, allowing us to test whether there are disparities in dementia risk and major factors driving dementia risk in Mexican Americans after accounting for migration patterns. This binational study will allow us to (Aim 1) quantify selective migration from Mexico to the US and return migration to Mexico as a function of established childhood and adult dementia risk factors that may influence migration patterns. We will then create a “propensity to migrate” score. This score will adopt a new approach to evaluating the contribution of social factors to selective migration bias, based on evaluating relative social position within Mexican Americans born in Mexico, US-born Mexican Americans, and US-born non-Latino whites, rather than directly comparing people with the same absolute social position. Using this score to account for selection bias, we will show the magnitude of (Aim 2) differences in dementia risk comparing Mexican Americans to US non-Latino whites and (Aim 3) differences in dementia risk associated with migration to the US, compared to people who remained in Mexico. The link between socioeconomic factors and health in Mexican Americans is uncertain, so we will (Aim 4) identify effects of education, household and neighborhood disadvantage, and discrimination on dementia risk of Mexican Americans, accounting for selective migration. This study will provide critical information about dementia risk in this growing US population and other disadvantaged or immigrant groups.

概括 关于墨西哥裔美国人的痴呆症分布知之甚少，墨西哥裔美国人包括美国大多数 （我们）拉丁裔。与非拉蒂诺相比 美国的白人，包括较低的教育，较低的社会经济地位和与移民有关的压力源。 尽管遭受了灾难，但有限的证据表明墨西哥裔美国人展出 痴呆率与非拉丁裔白人相似。墨西哥裔美国人的意外健康优势有 对于许多其他健康结果也可以观察到。选择性迁移，都是墨西哥健康的人 向美国，不健康的成年人返回迁移回墨西哥，是墨西哥的主要解释 美国的健康优势。痴呆症的几个已知危险因素也是从 墨西哥到美国。但是，没有工作量化选择性迁移及其引入的偏见 在痴呆症风险方面，墨西哥裔美国人和非拉丁裔白人之间的比较。因此，是 尚不清楚在纠正选择性后，墨西哥裔美国人是否存在痴呆症风险差异 迁移。在这项研究中，我们建议将来自两个统一的全国代表性同类的数据结合在一起 50岁以上的成年人：美国卫生和退休研究（HRS，n = 26,690，包括2,452个墨西哥裔美国人） 以及墨西哥健康与衰老研究（MHA，n = 13,798）。这些队列包括统一的纵向 与痴呆症风险有牢固相关的认知措施。选择性迁移几乎是 仅使用我们的数据不可能。结合了来自墨西哥和美国队列的数据，我们包括 移民和非移民，使我们能够测试痴呆症风险和主要因素是否存在差异 在考虑移民模式后，墨西哥裔美国人的痴呆症风险。这项二进制研究将 允许我们（AIM 1）量化从墨西哥到美国的选择性迁移，并返回墨西哥作为一个 可能影响迁移模式的童年和成人痴呆症风险因素的功能。我们将 然后创建一个“迁移倾向”得分。该分数将采用一种新方法来评估贡献 基于评估墨西哥境内相对社会地位的选择性迁移偏见的社会因素 美国人出生于墨西哥，美国出生的墨西哥裔美国人和美国出生的非拉丁裔白人，而不是直接 比较具有绝对社会地位的人。使用此分数来解释选择偏见，我们将 显示（AIM 2）痴呆症风险（AIM 2）的大小，将墨西哥裔美国人与我们非拉丁裔进行了比较 白人和（目标3）与向美国迁移相关的痴呆风险差异，与那些人相比 留在墨西哥。墨西哥裔美国人的社会经济因素与健康之间的联系尚不确定，因此 我们将（目标4）确定教育，家庭和邻里灾难的影响，并歧视 墨西哥裔美国人的痴呆症风险，占选择性迁移的影响。这项研究将提供关键 有关痴呆症风险的信息在美国不断增长的人口以及其他灾难或移民群体中。