Multi-Level Determinants of Sexual and Gender Minority Aging

性和性别少数群体老龄化的多层次决定因素

• 批准号: 10727086
• 负责人: Nathaniel M Tran
• 金额: $ 5.06万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-15 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10727086
• 关键词: Acceleration; Address; Adoption; Adult; Age; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Attitude; Award; Behavioral Risk Factor Surveillance System; Chronic; Clinical; Communities; Data; Decision Making; Discrimination; Disparity; Distress; Education; Elderly; Employment; Family member; Funding; Health; Health Personnel; Health Services; Health Status; Health behavior; Health system; Healthcare; High Prevalence; Home; Human immunodeficiency virus test; Illinois; Impaired cognition; Impairment; Inequity; Influenza vaccination; Intervention; Laws; Legal; Lesbian Gay Bisexual Transgender Queer; Life Cycle Stages; Malignant Neoplasms; Measures; Memory; Mental Health; Mentorship; Mississippi; Outcome; Patients; Physicians; Play; Policies; Population; Positioning Attribute; Prevalence; Preventive care; Preventive healthcare; Preventive service; Probability Samples; Provider; Psyche structure; Reporting; Research; Rights; Scholarship; Services; Severities; Sex Orientation; Sexual and Gender Minorities; Social Network; Social support; Spouses; Testing; Time; Training; United States; Universities; Vaccination; Work; aged; barrier to care; care seeking; checkup examination; colorectal cancer screening; cooking; dementia risk; design; experience; gender minority group; gender minority health; gender minority health disparity; health determinants; health disparity; health inequalities; health service use; healthy aging; high risk; human old age (65+); improved; informal care; insight; instrumental activity of daily living; middle age; minority patient; minority stress; novel; population health; programs; public health research; same-sex marriage; service gap; sex; sexual minority; sexual minority group

Project Abstract There are over 20 million sexual and gender minority (SGM) adults in the United States. SGM adults experience significant health inequities such as higher risk for Alzheimer’s Disease and related dementias (ADRD), higher prevalence and severity of chronic health conditions, and higher risk for multiple cancers. SGM discrimination likely accelerates aging, disrupts use of preventive care, and creates barriers to health systems when they are sick. The overall objective is to understand the relationship between provider- and policy-level factors to improve aging and health outcomes of midlife and older SGM adults. In Specific Aim 1, we will estimate population-level prevalence of subjective cognitive decline (SCD), severity of SCD, and receipt of informal care for SCD-related impairments using data from the 2015-2019 Behavioral Risk Factor Surveillance System (BRFSS). This is the largest probability sample of sexual minority (SM) adults available and all analyses will be stratified by sex and sexual orientation for the first time in public health research. We hypothesize that SM adults will report higher SCD prevalence and ADRD risk, but lower access to informal care provided by a spouse or family member. In Specific Aim 2, we will examine the relationship between 7 provider-level attitudes and practices towards SGM patients and preventive healthcare use (e.g., receiving colorectal cancer screenings, flu vaccinations) and level of cognitive impairment. This aim leverages novel panel data on midlife and older SGM adults from the NIA- funded Vanderbilt University Social Networks, Aging, and Policy Study (VUSNAPS). In Specific Aim 3, we will estimate the association of state policies legally permitting denial of health services based on sexual orientation and rates of preventive healthcare use, health status, and health behaviors among SM adults. In this aim, we will use BRFSS data and a difference-in-differences design to compare SM adults in states with and without legal denial policies. Results have significant implications for midlife and older SGM adults — an NIA priority population. By using the largest probability sample of SM adults available, we are able to stratify by sex and sexual orientation. These nuanced findings may inform policies regarding long-term supports and services to meet the needs of sub-populations with both SCD-related impairments and elevated risk for ADRD. Additionally, we use novel panel data on SGM midlife and older adults to identify provider-level predictors of preventive care. Research insights may inform larger scale interventions to improve attitudes and practices with SGM patients at the health system-level.

项目摘要 在美国，有超过2000万性和性别少数（SGM）成年人。 SGM成人经验 严重的健康不平等，例如阿尔茨海默氏病和相关痴呆症（ADRD）的较高风险，更高 慢性健康状况的患病率和严重程度，多种癌症的风险更高。 SGM歧视 可能会加速衰老，破坏预防性护理的使用，并在卫生系统时创造障碍 生病的。总体目标是了解提供者和政策级别因素之间的关系以改善 中年和年龄较大的SGM成年人的衰老和健康成果。在特定目标1中，我们将估计人口级别 主观认知能力下降（SCD）的患病率，SCD的严重程度以及与SCD相关的非正式护理 使用2015 - 2019年行为风险因素监视系统（BRFSS）的数据受损。这是 可用的性少数民族（SM）的最大概率样本，所有分析将按性别和性别进行分层 在公共卫生研究中首次进行性取向。我们假设SM成年人将报告更高 SCD患病率和ADRD风险，但较低的配偶或家人提供的非正式护理访问权限较低。在 具体目标2，我们将研究7位提供商级与会者与SGM的实践之间的关系 患者和预防性医疗保健（例如，接受结直肠癌筛查，流感疫苗）和水平 认知障碍。这个目标利用了来自NIA-的中年和年龄较大的SGM成年人的新小组数据 资助范德比尔特大学的社交网络，老龄化和政策研究（VUSNAPS）。在特定的目标3中，我们将 估计法律允许基于性取向拒绝卫生服务的国家政策协会 SM成年人的预防保健使用，健康状况和健康行为的速度。在这个目标中，我们 将使用BRFSS数据和差异差异设计来比较有或没有的州的SM成年人 法律否认政策。结果对中年和年长的SGM成年人具有重大影响 - NIA优先级 人口。通过使用可用的SM成年人的最大概率样本，我们可以按性别进行分层 性取向。这些细微的发现可能会为有关长期支持和服务的政策提供信息 满足与SCD相关的损害和ADRD风险升高的子人群的需求。此外， 我们使用有关SGM中年和老年人的新型面板数据来识别提供者级别的预防保健预测指标。 研究见解可能会为大规模干预措施提供信息，以提高与SGM患者的出勤率和实践 卫生系统级别。