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

利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

• 批准号: 10548284
• 负责人: Rita Hamad
• 金额: $ 9.17万
• 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/10548284
• 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; evidence base; follow-up; forest; high risk; indexing; innovation; machine learning method; member; 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 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，以阐明风险和保护因素。 阿尔茨海默氏病和相关痴呆症（ADRD），尤其是在少数民族中 居住的地方，居民和出生状态 始终与ADRD，中风和认知功能受损相关。 可修改的机制解释了关联，或者由于选择了关联是否为 不健康的人进入贫困地区。 了解邻国社会经济bascularr的影响的证据 风险因素。 以前关于邻居对ADRD的影响。 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”） 避免在主要城市中拥挤的时尚。 在30年的随访期间，丹麦至少60岁。 程序，创建自然实验，在该经验中，这些人是准随机分配的 剥夺水平不同的社区。 丹麦的人口和临床记录提供了有关社会杂志，临床相遇的数据， 和所有丹麦居民的处方。 临床登记册中使用验证的技术和prestistis数据，通过经过验证的技术在种族上多样化的队列。 已成功将寄存器与详细的地理编码数据源联系起来的八个措施 邻居的社会经济剥夺。 剥夺了生命2的后期ADRD的发病率，在AIM 2中，我们将检查邻居罩的影响 ADRD血管危险因素的剥夺，包括高度普遍的寿命 当然。 利用大样本量并完成 注册所有主题的数据。 统计技术，包括创新的机器学习方法，可以更加复杂和健壮 亚组识别将使未来的事件量身定制为最脆弱的人。 总体而言，这是预期的结果，以产生有关邻里影响的严格证据 关于ADRD和血管风险因素的特征，克服了以前的方法论挑战 工作将直接向临床，社区和政策策略的发展 最高风险的弱势群体中，ADRD的邻里确定。