Multilevel Forms of Structural Racism and Racial Inequalities in ADRD Risk

ADRD 风险中结构性种族主义和种族不平等的多层次形式

• 批准号: 10650393
• 负责人: TAYLOR HARGROVE
• 金额: $ 71.5万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10650393
• 关键词: 10 year old; Address; Adolescence; Adolescent; Adult; Age; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Alzheimer’s disease biomarker; American; Area; Biological; Biological Aging; Biological Markers; Black American; Black race; C-reactive protein; Censuses; Chronology; Communities; County; Criminal Justice; Data; Data Set; Databases; Dementia; Development; Diabetes Mellitus; Diagnosis; Discrimination; Disease; Early Intervention; Economics; Education; Educational Status; Effectiveness; Epigenetic Process; Ethnic Population; Expenditure; Exposure to; Geography; Goals; Growth; Health; Hypertension; Incidence; Individual; Inequality; Inflammation; Institution; Interleukins; Intervention; Investigation; Knowledge; Life; Life Cycle Stages; Light; Link; Location; Longitudinal Studies; Measures; Modeling; Motion; National Longitudinal Survey of Adolescent to Adult Health; Nature; Neurology; Onset of illness; Outcome; Pathway interactions; Physiological; Policies; Politics; Population; Public Health; Public Policy; Race; Research; Respondent; Risk; Risk Factors; Schools; Shapes; Skin; Stroke; Structural Racism; Techniques; Time; United States; Work; black/white disparity; cardiovascular health; causal model; cohort; cost; data repository; dementia risk; early onset; education pathway; experience; experimental study; health inequalities; insight; middle age; models and simulation; multiple data sources; neurofilament; novel; novel marker; population based; prospective; public health intervention; racial disparity; racial population; racism; residential segregation; school district; school environment; social; stressor; structural determinants; tau Proteins; theories; young adult

Project Summary/Abstract Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (AD/ADRD) are on the rise in the United States. Estimates project a 40% increase in AD among older Americans by 2025. This increase, along with its associated economic, social, and health burdens, are likely to have disproportionate impacts, as Black adults have the highest incidence of dementia of any racial/ethnic group in the U.S. Moreover, Black Americans experience higher rates of established biological risk factors for AD/ADRD, including hypertension, diabetes, stroke, inflammation, and biological aging. The expected growth in AD diagnoses, expenditures, and burdens, as well as potentially widening racial inequalities, make it imperative to investigate early risk factors for the development of AD/ADRD and racial inequalities in AD/ADRD. Structural forms of racism are likely important drivers of racial inequalities in AD/ADRD risk. Yet, much of the research in this area focuses on downstream factors, such as exposure to stressors and discrimination, or specific domains of structural racism at one point in time. Missing are longitudinal studies of structural racism and aging-related health inequalities across multiple geographic contexts. Further, there is limited knowledge of how public health and policy interventions addressing structural racism can be utilized to reduce racial inequalities in AD/ADRD. Causal modeling techniques provide opportunities to assess the impact of structural interventions on documented inequalities in biological risk factors for AD/ADRD using observational data. The purpose of this project is twofold: 1) to create a public-use, comprehensive data repository of multilevel and repeated contextual measures of structural racism; and 2) use the new contextual data in combination with existing contextual and individual-level longitudinal data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to examine specific pathways linking structural racism and AD/ADRD biological risk among early midlife U.S. adults. Specifically, we will investigate whether structural racism across educational, residential, and criminal justice contexts independently and jointly shape Black-White disparities in biological risk factors for AD/ADRD, including hypertension, diabetes, inflammation, epigenetic aging, and two novel biomarkers of AD/ADRD risk (neurofilament light and total tau). We will also use simulation models to compare the effects of hypothetical population-based policy changes and targeted interventions on racial inequalities in biological risk factors of AD/ADRD risk. Findings from this study will advance our understanding of how structural racism shapes AD/ADRD risk early in the life course. Results from simulation models will also inform the development of population-level, early interventions aimed to slow the progression of AD/ADRD risk and reduce health inequalities in these outcomes.

项目概要/摘要 阿尔茨海默病和阿尔茨海默病相关痴呆症 (AD/ADRD) 在美国呈上升趋势 据估计，到 2025 年，美国老年人患 AD 的比例将增加 40%。 相关的经济、社会和健康负担，可能会产生不成比例的影响，因为黑人成年人 在美国所有种族/族裔群体中，黑人的痴呆症发病率最高。 AD/ADRD 的既定生物危险因素的发生率较高，包括高血压、糖尿病、 中风、炎症和生物衰老。AD 诊断、支出和负担的预期增长。 以及可能扩大的种族不平等，因此必须调查早期的风险因素 AD/ADRD 的发展以及 AD/ADRD 中的种族不平等可能很重要。 然而，该领域的大部分研究都集中在下游。 因素，例如暴露于压力源和歧视，或在某一时刻出现结构性种族主义的特定领域 及时缺少对结构性种族主义和与老龄化相关的健康不平等的纵向研究。 此外，对于如何进行公共卫生和政策干预的了解有限。 解决结构性种族主义可用于减少 AD/ADRD 因果模型中的种族不平等。 技术提供了评估结构性干预措施对记录在案的不平等的影响的机会 使用观察数据确定 AD/ADRD 的生物风险因素 该项目的目的有两个：1) 创建。 一个公共使用的综合数据存储库，包含结构性的多层次和重复的上下文测量 种族主义；2）结合现有的背景和个人层面使用新的背景数据 来自国家青少年至成人健康纵向研究（Add Health）的纵向数据进行检查 美国中年早期成年人的结构性种族主义和 AD/ADRD 生物风险的特定联系途径。 具体来说，我们将调查教育、居住和刑事司法领域是否存在结构性种族主义 背景独立和共同塑造 AD/ADRD 生物风险因素中的黑白差异， 包括高血压、糖尿病、炎症、表观遗传衰老以及 AD/ADRD 风险的两种新型生物标志物 （神经丝光和总 tau 蛋白）我们还将使用模拟模型来比较假设的效果。 基于人口的政策变化和针对生物危险因素中种族不平等的有针对性的干预措施 这项研究的结果将增进我们对结构性种族主义如何形成的理解。 生命历程早期的 AD/ADRD 风险也将为 AD/ADRD 风险的发展提供信息。 人口层面的早期干预措施旨在减缓 AD/ADRD 风险的进展并降低健康水平 这些结果的不平等。