Evaluation of college accessibility and income security interventions as preventative measures for dementia risk and solutions to dementia disparities

对大学入学机会和收入保障干预措施作为痴呆症风险预防措施和痴呆症差异解决方案的评估

• 批准号: 10054598
• 负责人: Anusha Murthy Vable
• 金额: $ 62.24万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10054598
• 关键词: Address; Adult; Affect; African American; Age; Alzheimer' s Disease; Birth; Cause of Death; Cerebrovascular Disorders; Childhood; Chronic; Clinical; Cognitive; Country; Data Set; Date of birth; Dementia; Diagnosis; Dimensions; Disease; Education; Educational Intervention; Educational Status; Elderly; Evaluation; Future; Geography; Goals; Health; Health and Retirement Study; Health behavior; Incidence; Income; Income Tax; Individual; Institution; Intervention; Link; Literature; Long-Term Effects; National Longitudinal Survey of Youth; Neurodegenerative Disorders; Participant; Pattern; Pensions; Policies; Population; Preventive measure; Process; Publishing; Randomized; Reasons for Geographic And Racial Differences in Stroke; Research; Retirement; Risk; Schools; Security; Social Policies; Social Security; Socioeconomic Status; Structure; Subgroup; Testing; United States; United States National Institutes of Health; Variant; Veterans; Vietnam; Vulnerable Populations; War; Work; cohort; college; dementia risk; disorder risk; early life exposure; health data; health disparity; higher education; improved; poverty alleviation; racial and ethnic; rural area; social health determinants; social interventions; social vulnerability; sociodemographics; socioeconomic disparity; socioeconomics; trend

ABSTRACT. Alzheimer's Disease and Related Disorders (ADRD) are leading causes of death in the United States that disproportionately impact individuals with less education and income. There is substantial evidence that ADRD is strongly patterned by socioeconomic status across the lifecourse. However, little prior work has evaluated whether socioeconomic interventions to increase socioeconomic status reduce the population burden of ADRD, or if there are differentially effects by sociodemographic subgroup, resulting in smaller disparities; this proposal addresses this critical gap in the literature. We evaluate socioeconomic interventions that increased years of education (Aim 1) and income security (Aim 2) to determine if such interventions impacted dementia risk overall, and whether structurally minoritized groups (Black Americans, individuals from low childhood SES backgrounds, and people who grew up in rural areas or the South) differentially benefited (Aim 3). We will use data from Health and Retirement Study (HRS), the Reasons for Geographic and Racial Differences in Stroke cohort (REGARDS), and the National Longitudinal Survey of Youth, 1979 cohort to evaluate these aims. Our research team has previously published using all three data sets. Aim 1 will evaluate whether expansion of college access reduced ADRD risk; hypothesis 1 evaluates college geographic accessibility via increases in 2 and 4-year higher education institutions per capita, while hypothesis 2 evaluates college financial accessibility via a large social intervention that subsidized college education (the Vietnam War GI Bill). Aim 2 will evaluate whether policies that increased income security reduced ADRD risk; hypothesis 1 evaluates the long-term effects of a working age poverty-alleviation policy (the earned income tax credit), while hypothesis 2 evaluates retirement income security (Social Security). Aim 3 will evaluate whether the education and income security interventions examined in Aims 1 and 2 reduced socioeconomic, racial, and geographic disparities in ADRD; differential effects will be evaluated using interaction terms, quantile regression, and distributional decomposition. If our hypotheses are confirmed, results from this research will provide direct evidence for solutions to reduce the future population burden of ADRD and disparities in ADRD. Our work can also inform targeting of interventions to those who benefit most. This research will provide immediately actionable evidence, because the interventions we evaluate are specific and feasible.

抽象的。阿尔茨海默氏病和相关疾病（ADRD）是统一死亡的主要原因 指出，对教育和收入较少的个人产生不成比例的影响。有大量证据 在整个生命过程中，这种adrd是由社会经济地位强烈的。但是，先前的工作几乎没有 评估社会经济干预措施是否增加社会经济地位减轻了人口负担 ADRD，或者如果社会人口统计学亚组有差异的影响，导致差异较小；这 提案解决了文献中的这一关键差距。我们评估社会经济干预措施，以增加 多年教育（目标1）和收入安全（目标2）来确定这种干预措施是否影响痴呆症 总体风险，以及结构少的群体（黑人美国人，低童年的个人） 背景，以及在农村地区或南部长大的人们都受益匪浅（AIM 3）。我们将使用 来自健康和退休研究（HRS）的数据，中风的地理和种族差异的原因 1979年，同时（问起）和全国对青年纵向调查，以评估这些目标。我们的 研究团队先前使用了所有三个数据集发表。 AIM 1将评估是否扩展 大学访问降低了ADRD风险；假设1通过增加2个评估大学地理可及性 和4年的高等教育机构人均高等教育机构，而假设2评估大学财务可访问性 通过对大学教育补贴的大型社会干预（越南战争GI法案）。 AIM 2将评估 提高收入保险的政策是否降低了ADRD风险；假设1评估长期影响 工作年龄贫困 - 利用政策（赚取的所得税信用），而假设2评估 退休收入保障（社会保障）。 AIM 3将评估教育和收入安全是否 在目标1和2中检查的干预措施减少了ADRD的社会经济，种族和地理差异； 将使用交互项，分位数回归和分布来评估差异效应 分解。如果确认我们的假设，这项研究的结果将为直接证据 减轻ADRD未来人口负担和ADRD差异的解决方案。我们的工作也可以告知 针对受益最大的人的干预措施。这项研究将提供立即可行的证据， 因为我们评估的干预措施是具体且可行的。