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 美国有超过 2000 万性少数群体 (SGM) 成年人经历过 SGM。 严重的健康不平等，例如阿尔茨海默氏病和相关痴呆症 (ADRD) 的风险较高， 慢性健康状况的患病率和严重程度，以及多种癌症的较高风险。 可能会加速老龄化，扰乱预防性护理的使用，并给卫生系统造成障碍 总体目标是了解提供者层面因素和政策层面因素之间的关系以进行改善。 在具体目标 1 中，我们将估计人口水平。 主观认知能力下降 (SCD) 的患病率、SCD 的严重程度以及接受 SCD 相关的非正式护理 使用 2015-2019 年行为风险因素监测系统 (BRFSS) 的数据来评估损伤。 现有性少数 (SM) 成年人的最大概率样本，所有分析都将按性别和性别进行分层 性取向首次出现在公共卫生研究中，我们努力争取 SM 成年人的报告更高。 SCD 患病率和 ADRD 风险较高，但获得配偶或家庭成员提供的非正式护理的机会较少。 具体目标2，我们将研究7个提供商层面对SGM的态度和做法之间的关系 患者和预防性医疗保健使用（例如接受结直肠癌筛查、流感疫苗接种）和水平 这一目标利用了 NIA- 中年和老年 SGM 成年人的新面板数据。 资助范德堡大学社交网络、老龄化和政策研究 (VUSNAPS)，在具体目标 3 中，我们将 估计法律上允许基于性取向拒绝提供医疗服务的国家政策的关联性 SM 成年人的预防性医疗保健使用率、健康状况和健康行为。 将使用 BRFSS 数据和双重差分设计来比较有和没有州的 SM 成年人 法律拒绝政策的结果对中年和老年 SGM 成年人具有重大影响——这是 NIA 的优先事项。 通过使用现有 SM 成年人的最大概率样本，我们能够按性别和年龄进行分层。 这些微妙的发现可能会为有关长期支持和服务的政策提供信息。 此外，满足患有 SCD 相关损伤和 ADRD 风险较高的亚人群的需求， 我们使用 SGM 中年和老年人的新颖面板数据来确定预防性护理的提供者级别的预测因素。 研究见解可能会为更大规模的干预措施提供信息，以改善 SGM 患者的态度和实践 卫生系统层面。