Alzheimer’s Disease and Related Dementias in The Most Incarcerated Generation: An Understudied Population with Health Disparities

被监禁最多的一代人中的阿尔茨海默氏病和相关痴呆症：健康差异尚未得到充分研究的人群

• 批准号: 10663035
• 负责人: LISA C BARRY
• 金额: $ 79.53万
• 依托单位: NORTHERN CALIFORNIA INSTITUTE/RES/EDU
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10663035
• 关键词: Acceleration; Affect; Age; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; American; Back; Behavioral Model; Black race; Blood Vessels; Capsicum; Characteristics; Communities; Crime; Criminal Justice; Data; Dementia; Diagnosis; Disease; Elderly; Enabling Factors; Enrollment; Environment; Epidemiology; Ethnic Origin; Exclusion; Funding; Generations; Grouping; HIV/AIDS; Health; Health Status; Healthcare Systems; Hispanic; Homelessness; Imprisonment; Indigenous; Individual; Intervention; Justice; Link; Longitudinal cohort; Medical; Medicare; Modeling; Not Hispanic or Latino; Outcome; Pathway interactions; Patients; Persons; Policies; Population; Poverty; Predisposing Factor; Prisons; Probability; Public Health; Race; Recording of previous events; Reduce health disparities; Research; Risk; Risk Factors; Sampling; Substance Use Disorder; Target Populations; Time; Transitional Care Planning; Unemployment; United States Centers for Medicare and Medicaid Services; United States National Institutes of Health; Veterans; Veterans Health Administration; Vulnerable Populations; cohort; community reentry; contextual factors; dementia care; dementia risk; demographics; disability; emerging adult; experience; health disparity; health disparity populations; high risk; interest; longitudinal dataset; low socioeconomic status; mild cognitive impairment; multidisciplinary; multiple chronic conditions; novel; people of color; profiles in patients; response; risk mitigation; severe mental illness; sex; social; socioeconomic disadvantage

The proposed project, which responds to NOT-AG-21-033 (Health Disparities and Alzheimer’s Disease), is the first longitudinal and epidemiological examination of justice-involvement and dementia. Americans who experience justice-involvement, moving from the community to incarceration and from incarceration back to the community, are aging rapidly. Moreover, justice-involvement disproportionately impacts persons of color and of low socioeconomic status, who are also at high risk for all forms of dementia yet are frequently excluded from dementia-related research. This study will contribute to our understanding of health disparities in dementia by evaluating the inter-relationship among incarceration, dementia, and a number of important social risk factors and multi-morbidity factors over time in a national sample. We will optimize the Veterans Health Administration’s (VHA) capacity to access Incarceration History Files from the Centers for Medicare and Medicaid Services (CMS). We propose to leverage a longitudinal “prison release” cohort which we created for a different NIH-funded study and supplement (R01 MH117604 and S1). This cohort includes >30,000 individuals enrolled in both Medicare and VHA, who reentered the community at age ≥50 (between 2008-2018) following an incarceration. We will enhance this cohort to include all veterans who were age ≥50 between 2008 to 2022, including those incarcerated at any point during that timeframe and who were released, those who remained incarcerated (no community reentry), and those never incarcerated, for a total of more than 46,000 justice-involved veterans among 10.5 million veterans. Using this rich, longitudinal dataset, we have the unprecedented opportunity to develop social risk factor profiles and multi-morbidity profiles associated with risk of incarceration among those with dementia (Aim 1) and risk of dementia among those released from incarceration (Aim 2). Access to VA and Medicare data provides more complete outcome ascertainment, thus increasing the opportunity to determine if these profiles differ according to dementia subtypes (e.g., Alzheimer’s Disease, vascular, frontotemporal, mild cognitive impairment (MCI)). We will also make novel use of transition models to evaluate probabilities of experiencing distinct pathways (e.g., pathway to entering incarceration, to being released from incarceration, to developing dementia) and determine precursors that predict these pathways (Aim 3). We will evaluate all Aims within health disparity populations such as non- Hispanic Black, Hispanic, native/indigenous groups and those experiencing indicators of poverty (e.g., homelessness and socioeconomic disadvantage). This study has substantial public health significance. It will inform strategies to mitigate risk of patients with dementia entering incarceration, will delineate those at highest risk of developing dementia after incarceration so as to inform prison-to-community transitional care planning, and will identify prime intervention points where optimizing dementia care could reduce health disparities between those with and without justice-involvement and even within the justice-involved.

拟议的项目对NOT-AG-21-033（健康差异和阿尔茨海默氏病）的回应是 首次纵向和流行病学研究对正义参与和痴呆症。美国人谁 体验大法官参与，从社区转移到增加并从增加到返回 社区，正在迅速衰老。此外，司法参议不成比例地影响有色人种和 低社会经济地位，他们对各种形式的痴呆症也有高风险，但经常被排除在外 与痴呆有关的研究。这项研究将有助于我们对痴呆症健康差异的理解 评估发生，痴呆症和许多重要的社会风险因素之间的相互关系 在国家样本中，随着时间的流逝，多物种因素。我们将优化退伍军人健康 政府（VHA）从Medicare和 医疗补助服务（CMS）。我们建议利用我们为 NIH资助的另一项研究和补充（R01 MH117604和S1）。这个队列包括> 30,000 参加了Medicare和VHA的个人，他们在≥50岁的社区重新进入（2008-2018之间） 在增加之后。我们将增强该队列，包括2008年之间所有年龄≥50岁的退伍军人 到2022 仍然是继承的（没有社区重新进入），而从未继承的人，总共超过46,000 在1,050万退伍军人中涉及正义的退伍军人。使用这个丰富的纵向数据集，我们有 前所未有的机会来开发与风险相关的社会风险因素概况和多元车概况 患有痴呆症患者的进化（目标1）和痴呆症的风险 监禁（目标2）。访问VA和Medicare数据提供了更完整的结果确定，因此 增加机会确定这些特征是否根据痴呆症亚型（例如， 阿尔茨海默氏病，血管，额颞，轻度认知障碍（MCI））。我们还将进行新颖 过渡模型评估体验不同途径的可能性（例如，进入的途径 监禁，从监禁中释放到发展痴呆症），并确定前体 预测这些途径（AIM 3）。我们将评估健康差异人群中的所有目标，例如非 - 西班牙裔黑人，西班牙裔，本地/土著群体以及经历贫困指标的人（例如， 无家可归和社会经济劣势）。这项研究具有实质性的公共卫生意义。会 告知策略以减轻痴呆症患者进入事件的风险，将描述那些处于最高的 事故发生后患痴呆症的风险，以告知监狱到社区过渡护理计划， 并将确定优化痴呆护理可以减少健康差异的主要干预点 在有和没有正义参与司法诉讼的人之间。