Community Empowerment, Vascular Risk, and ADRD Disparities: Translating Research to Public Policy

社区赋权、血管风险和 ADRD 差异：将研究转化为公共政策

• 批准号: 10723077
• 负责人: Kendra D Sims
• 金额: $ 12.22万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10723077
• 关键词: Acceleration; Adult; Alzheimer' s disease related dementia; Alzheimer' s disease risk; American; Area; Award; Black Populations; Black race; Blood Vessels; California; Cardiovascular Diseases; Censuses; Characteristics; Clinical; Collaborations; Communities; Community Surveys; County; Data; Data Science; Depressed mood; Deterioration; Development; Disparity; Economic Factors; Economics; Elderly; Ensure; Event; Exclusion; Faculty; Foundations; Future; Goals; Health Care Costs; Health Policy; Health and Retirement Study; Housing; Incidence; Infrastructure; Institution; Intervention; Investments; Joints; Knowledge; Lead; Link; Low income; Machine Learning; Mediating; Mediator; Medicare; Medicare claim; Mentors; Mentorship; Minority; Modeling; Neighborhoods; Pattern; Phase; Policies; Political Factor; Politics; Population; Population Attributable Risks; Positioning Attribute; Prevalence; Prevention; Public Health; Public Policy; Race; Racial Segregation; Reasons for Geographic And Racial Differences in Stroke; Relative Risks; Research; Research Personnel; Resources; Risk; Risk Estimate; Risk Factors; Role; Sampling; San Francisco; Science; Social Environment; Stroke Belt; Structural Racism; Surveys; Training; Translating; University resources; Variant; beneficiary; black/white disparity; burden of illness; cardiovascular disorder epidemiology; cardiovascular disorder risk; cardiovascular effects; cohort; community-level factor; cultural competence; dementia risk; demographics; disparity reduction; economic indicator; empowerment; innovation; marginalization; mortality; neighborhood disadvantage; policy implication; prevent; racial disparity; residence; scale up; segregation; skills; socioeconomics; success; systemic barrier

PROJECT SUMMARY ABSTRACT By 2050, racial disparities will persist among the projected 11 million adults with Alzheimer’s Disease and Related Dementias (AD/ADRD). Prior research links racial segregation to AD/ADRD, highlighting the need for structural solutions to mitigate the racially patterned cardiovascular disease (CVD) burden that accelerates AD/ADRD onset. Economic disinvestment prevents Black, poor, and Stroke Belt neighborhoods from investing in their local infrastructure, while systemic barriers lead to political disenfranchisement among the very historically excluded groups who would benefit most from effective health policy. However, it is not known how disinvestment and disenfranchisement—factors produced by structural racism—contribute to AD/ADRD disparities via excess CVD risk. This proposed K99/R00 harnesses the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, Health and Retirement Study (HRS), and administrative claims from Medicare Beneficiaries. For my K99 phase, I will identify indicators of economic disinvestment and political disenfranchisement that worsen AD/ADRD trajectories and widen racial disparities in REGARDS and HRS. Then I will use these results to calculate the population attributable fraction of disinvestment and disenfranchisement on AD/ADRD among Medicare Beneficiaries. During my R00 phase, I will analyze the mediating role of CVD in associations of disinvestment or disenfranchisement and incident AD/ADRD in Medicare claims. Finally, I will utilize the CVD Policy Model to forecast nationwide community empowerment policies to reduce CVD risk factors for AD/ADRD up to three decades in the future. Building upon my foundation of data science, causal inference, and CVD epidemiology, my training plan consists of new knowledge domains: 1) AD/ADRD science, 2) spatial modeling, 3) Medicare claims, and 4) estimation of public health impact attainable with structural interventions. Based at the richly resourced University of California, San Francisco, I have assembled a team of distinguished mentors with the ideal combination of expertise to facilitate my success. The integrated science, training, mentorship, and professional development will prepare me for a faculty position at an R1 institution. My longterm goal is to become an independent investigator who develops interventions and policies to prevent AD/ADRD among low-income, Black, and Stroke Belt communities.

项目摘要摘要 到2050年，预计有1100万阿尔茨海默氏病的成年人将继续存在种族差异 相关痴呆症（AD/ADRD）。先前的研究将种族隔离连接到广告/ADRD，突出显示 需要结构性解决方案来减轻种族歧视的心血管疾病（CVD）Burnen 加速AD/ADRD发作。经济投资可以防止黑色，贫穷和中风带 从投资本地基础设施的社区，而系统性障碍则导致政治 在历史上排斥的团体中，剥夺了公民权，他们将从有效中受益最大 卫生政策。但是，尚不清楚如何进行宣传和剥夺权利 - 由 结构性种族主义 - 通过超过CVD风险归因于AD/ADRD差异。 这提出了k99/r00，这利用了中风的地理和种族差异的原因 （有关）研究，健康和退休研究（HRS）以及Medicare的行政主张 受益人。对于我的K99阶段，我将确定经济投资和政治投资的指标 剥夺广告/ADD轨迹和广泛的种族差异的剥夺权利 HRS。然后，我将使用这些结果来计算投资投资的可归因于可归因于 在医疗保险受益人中，对AD/ADRD的剥夺权利。在我的R00阶段，我将分析 CVD在撤销或剥夺合法性和事件AD/ADRD协会中的中介作用 Medicare主张。最后，我将利用CVD政策模型来预测全国社区 授权政策可将AD/ADRD的CVD风险因素降低到未来的三十年。 在我的数据科学，因果推理和CVD流行病学的基础上，我的培训计划 由新知识领域组成：1）AD/ADRD科学，2）空间建模，3）Medicare主张和 4）通过结构性干预措施可以估算公共卫生影响。 我在加利福尼亚大学旧金山的富裕分校的总部集会了一个团队 具有理想的专家组合以促进我的成功。集成 科学，培训，心态和专业发展将为我做好准备 R1机构。我的长期目标是成为制定干预措施和的独立调查员 在低收入，黑色和中风带社区中预防广告/ADRD的政策。

项目成果

Projected Impact of Nonpharmacologic Management of Stage 1 Hypertension Among Lower-Risk US Adults.

非药物治疗对低风险美国成年人 1 期高血压的预计影响。

• DOI: 10.1101/2023.12.26.23300563
• 发表时间: 2023
• 期刊: medRxiv : the preprint server for health sciences
• 作者: Sims,KendraD;Wei,PengxiaoCarol;Penko,JoanneM;Hennessy,Susan;Coxson,PamelaG;Mukand,NitaH;Bellows,BrandonK;Kazi,DhruvS;Zhang,Yiyi;Boylan,Ross;Moran,AndrewE;Bibbins-Domingo,Kirsten
• 通讯作者: Bibbins-Domingo,Kirsten