Alzheimer’s Disease and Related Dementias in The Most Incarcerated Generation: An Understudied Population with Health Disparities

被监禁最多的一代人中的阿尔茨海默氏病和相关痴呆症：健康差异尚未得到充分研究的人群

• 批准号: 10663035
• 负责人: LISA C BARRY
• 金额: $ 79.53万
• 依托单位: NORTHERN CALIFORNIA INSTITUTE/RES/EDU
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10663035
• 关键词: Acceleration; Affect; Age; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; American; Back; Behavioral Model; Black race; Blood Vessels; Capsicum; Characteristics; Communities; Crime; Criminal Justice; Data; Dementia; Diagnosis; Disease; Elderly; Enabling Factors; Enrollment; Environment; Epidemiology; Ethnic Origin; Exclusion; Funding; Generations; Grouping; HIV/AIDS; Health; Health Status; Healthcare Systems; Hispanic; Homelessness; Imprisonment; Indigenous; Individual; Intervention; Justice; Link; Longitudinal cohort; Medical; Medicare; Modeling; Not Hispanic or Latino; Outcome; Pathway interactions; Patients; Persons; Policies; Population; Poverty; Predisposing Factor; Prisons; Probability; Public Health; Race; Recording of previous events; Reduce health disparities; Research; Risk; Risk Factors; Sampling; Substance Use Disorder; Target Populations; Time; Transitional Care Planning; Unemployment; United States Centers for Medicare and Medicaid Services; United States National Institutes of Health; Veterans; Veterans Health Administration; Vulnerable Populations; cohort; community reentry; contextual factors; dementia care; dementia risk; demographics; disability; emerging adult; experience; health disparity; health disparity populations; high risk; interest; longitudinal dataset; low socioeconomic status; mild cognitive impairment; multidisciplinary; multiple chronic conditions; novel; people of color; profiles in patients; response; risk mitigation; severe mental illness; sex; social; socioeconomic disadvantage

The proposed project, which responds to NOT-AG-21-033 (Health Disparities and Alzheimer’s Disease), is the first longitudinal and epidemiological examination of justice-involvement and dementia. Americans who experience justice-involvement, moving from the community to incarceration and from incarceration back to the community, are aging rapidly. Moreover, justice-involvement disproportionately impacts persons of color and of low socioeconomic status, who are also at high risk for all forms of dementia yet are frequently excluded from dementia-related research. This study will contribute to our understanding of health disparities in dementia by evaluating the inter-relationship among incarceration, dementia, and a number of important social risk factors and multi-morbidity factors over time in a national sample. We will optimize the Veterans Health Administration’s (VHA) capacity to access Incarceration History Files from the Centers for Medicare and Medicaid Services (CMS). We propose to leverage a longitudinal “prison release” cohort which we created for a different NIH-funded study and supplement (R01 MH117604 and S1). This cohort includes >30,000 individuals enrolled in both Medicare and VHA, who reentered the community at age ≥50 (between 2008-2018) following an incarceration. We will enhance this cohort to include all veterans who were age ≥50 between 2008 to 2022, including those incarcerated at any point during that timeframe and who were released, those who remained incarcerated (no community reentry), and those never incarcerated, for a total of more than 46,000 justice-involved veterans among 10.5 million veterans. Using this rich, longitudinal dataset, we have the unprecedented opportunity to develop social risk factor profiles and multi-morbidity profiles associated with risk of incarceration among those with dementia (Aim 1) and risk of dementia among those released from incarceration (Aim 2). Access to VA and Medicare data provides more complete outcome ascertainment, thus increasing the opportunity to determine if these profiles differ according to dementia subtypes (e.g., Alzheimer’s Disease, vascular, frontotemporal, mild cognitive impairment (MCI)). We will also make novel use of transition models to evaluate probabilities of experiencing distinct pathways (e.g., pathway to entering incarceration, to being released from incarceration, to developing dementia) and determine precursors that predict these pathways (Aim 3). We will evaluate all Aims within health disparity populations such as non- Hispanic Black, Hispanic, native/indigenous groups and those experiencing indicators of poverty (e.g., homelessness and socioeconomic disadvantage). This study has substantial public health significance. It will inform strategies to mitigate risk of patients with dementia entering incarceration, will delineate those at highest risk of developing dementia after incarceration so as to inform prison-to-community transitional care planning, and will identify prime intervention points where optimizing dementia care could reduce health disparities between those with and without justice-involvement and even within the justice-involved.

拟议的项目响应 NOT-AG-21-033（健康差异和阿尔茨海默病），是 首次对美国人的司法参与和痴呆症进行纵向和流行病学调查。 体验正义参与，从社区到监禁，再从监禁回到监狱 此外，司法参与对有色人种和有色人种的影响尤为严重。 社会经济地位低，患各种形式痴呆症的风险也很高，但经常被排除在外 这项研究将有助于我们了解痴呆症的健康差异。 评估监禁、痴呆症和一些重要社会风险因素之间的相互关系 我们将优化退伍军人的健康状况。 政府 (VHA) 从医疗保险中心访问监禁历史文件的能力 我们建议利用我们为之创建的纵向“监狱释放”队列。 另一项 NIH 资助的研究和补充（R01 MH117604 和 S1）该队列包括超过 30,000 例。 同时加入 Medicare 和 VHA 并在 50 岁以上重新进入社区的个人（2008 年至 2018 年期间） 我们将扩大这一群体，将 2008 年期间年龄≥50 岁的所有退伍军人纳入其中。 到 2022 年，包括在此期间任何时候被监禁和被释放的人、 仍然被监禁的人（不能重返社区）以及从未被监禁的人，总数超过 46,000 人 利用这个丰富的纵向数据集，我们获得了 1050 万退伍军人中涉及正义的退伍军人。 开发与风险相关的社会风险因素概况和多种发病概况的前所未有的机会 痴呆症患者的入狱率（目标 1）以及从监狱释放的患者患痴呆症的风险 获得 VA 和医疗保险数据可以提供更完整的结果确定，从而 增加确定这些特征是否因痴呆亚型而异的机会（例如， 阿尔茨海默病、血管病、额颞叶病、轻度认知障碍（MCI））我们还将做出新的用途。 过渡模型来评估经历不同路径的概率（例如，进入 监禁，从监禁中释放，发展为痴呆症）并确定前兆 预测这些途径（目标 3）。我们将评估健康差异人群中的所有目标，例如非健康人群。 西班牙裔黑人、西班牙裔、原住民/原住民群体以及那些经历贫困指标的群体（例如， 无家可归和社会经济不利）这项研究具有重大的公共卫生意义。 告知降低痴呆症患者入狱风险的策略，将确定最高风险的患者 监禁后患痴呆症的风险，以便为监狱到社区的过渡护理规划提供信息， 并将确定优化痴呆症护理可以减少健康差异的主要干预点 正义介入者与非正义介入者之间，甚至正义介入者内部。