Identifying and Addressing Social Determinants of Health to Reduce the National Burden of and Inequities in Dementia

识别和解决健康的社会决定因素，以减轻痴呆症的国家负担和不平等现象

基本信息

批准号：
10597433
负责人：
Daniel Kim
金额：
$ 238.05万
依托单位：
NORTHEASTERN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-01-01 至 2025-12-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10597433
关键词：
Address Adjusted Life Years Adult Affect Age All of Us Research Program Alzheimer&apos s disease related dementia Alzheimer&apos s disease risk American Area Biological Markers Cause of Death Cessation of life Cognitive Communities Cost Savings DNA Methylation Data Databases Dementia Diagnosis Disparity Economics Education Elderly Electronic Health Record Epidemiology Ethnic Origin Future Gender Goals Health Health and Retirement Study Hospitals Hypertension Impaired cognition Incidence Inequity Knowledge Left Length Life Expectancy Link Longitudinal Studies Machine Learning Measures Mediation Medicare claim Memory Memory Loss Mental Depression Mental disorders Modeling Outpatients Participant Pathway interactions Policies Policy Maker Population Prevention Research Productivity Public Policy Quality-Adjusted Life Years Quasi-experiment Race Risk Risk Factors Shapes Social Mobility Social Security Socioeconomic Status Taxes Testing Translating United States United States National Institutes of Health Vulnerable Populations Wages Woman comparative cost development policy economic impact ethnic minority population evidence base health data health disparity populations improved innovation longitudinal dataset middle age models and simulation mortality mortality disparity multi-ethnic novel physical conditioning population health predictive modeling protective factors public health relevance racial minority population response risk mitigation social social determinants social health determinants telomere tool translational impact

项目摘要

PROJECT SUMMARY/ABSTRACT Alzheimer’s disease and related dementias (ADRD) are an escalating national crisis that shapes overall levels of population health including average life expectancy. Critically, in order to effectively address this crisis, it is imperative that we identify its root causes, which may include social determinants of health (SDoH) such as education spending and social mobility, and that we modify these root causes through corresponding policies. While a handful of SDoH have been shown to predict cognitive decline and ADRD, important questions remain about which SDoH are root social drivers i.e., have the greatest impacts. Despite increasing calls for comparative assessments to unpack and address the root causes—the social determinants—of ADRD, we lack knowledge on the relative ADRD burden and economic impacts associated with modifying SDoH, including policies such as the social security benefits tax. Furthermore, we have yet to establish which subpopulations are most affected by SDoH. Given this information, there are critical needs to accurately estimate SDoH impacts, including by subpopulation; and to translate these estimates into priority-setting tools including impacts on ADRD burden and costs. Left unaddressed, these critical needs will hinder the development of policies to more effectively reduce ADRD burden and inequities. Our overall objective is to use large multilevel, longitudinal datasets and quasi-experimental approaches to construct the first comparative assessment evidence base on the social drivers of ADRD burden and inequities. We will accomplish our overall objective by pursuing the following specific aims using data in adults age 50+ from: the nationally-representative Mortality Disparities in American Communities Study, linked to national mortality databases; the nationally-representative Health and Retirement Study, linked to Medicare claims data; and the NIH’s All of Us Program, a multiethnic study linked to electronic health records (EHR) data on diagnoses/treatments of health conditions: Aim 1) To assess the impacts of area-level SDoH including state policies as protective factors against ADRD mortality, that may vary across health disparity populations; Aim 2) To evaluate the impacts of area-level SDoH on memory decline in middle-aged adults and incidence of cognitive impairment and dementia in older adults; Aim 3) To explore the mechanisms through which area-level SDoH may protect against ADRD incidence and cognitive impairment/decline, including physical/mental health disorders and biomarkers; and Aim 4) To ascertain which area-level SDoH, if modified, are expected to yield the greatest reductions in levels of and inequities in ADRD burden and costs. Regarding impact, we will identify the most promising SDoH on which to intervene to yield improvements in ADRD burden and inequities. We will further establish the pathways to differential vulnerabilities by subpopulation. By translating estimates into population health metrics, we anticipate our project will have high translational impact through guiding policymakers' evidence-based decisions about policies to more effectively reduce the burden of and inequities in ADRD among Americans.

项目摘要/摘要阿尔茨海默氏病和相关痴呆症（ADRD）是一种不断升级的国家危机，塑造了整体水平人口健康，包括平均预期寿命。至关重要的是，为了有效解决这一危机，这是我们必须确定其根本原因，其中可能包括健康的社会决定者（SDOH），例如教育支出和社会流动性，我们通过相应的政策修改了这些根本原因。虽然已经显示出少数SDOH可以预测认知能力下降和ADRD，但重要的问题仍然存在关于哪些SDOH是根源的社会驱动力，即产生最大的影响。尽管越来越多的电话比较评估以解开和解决根本原因（社会决定者），我们缺乏了解相对aDrd伯恩的知识以及与修改SDOH相关的经济影响，包括政策，例如社会保障福利税。此外，我们尚未确定哪些亚群受SDOH影响最大。鉴于此信息，有至关重要的需要准确估计SDOH的影响，包括亚种群；并将这些估计值转化为优先设定工具，包括对ADRD的影响负担和费用。剩下的未解决，这些关键需求将阻碍政策的制定有效地减少伯宁和不平等。我们的总体目标是使用大型多级，纵向数据集和准实验方法来构建第一个比较评估证据基于Adrd Burn和不平等的社会驱动力。我们将通过追求来实现我们的整体目标以下特定目的使用50岁以上的成年人的数据来自：全国代表性的死亡率差异在美国社区研究中，与国家死亡率数据库有关；全国代表性的健康和退休研究，与Medicare索赔数据有关；以及美国国立卫生研究院的所有计划，一项与电子健康记录（EHR）有关健康状况诊断/治疗的数据：目的1）评估区域级别的SDOH的影响，包括国家政策是针对ADRD死亡率的保护因素，在健康差异人群中可能会有所不同；目标2）评估区域级SDOH对中年成年人的记忆力下降以及老年认知障碍和痴呆症的发生成年人;目标3）探索区域级SDOH可以防止ADRD的机制发病率和认知障碍/下降，包括身体/心理健康障碍和生物标志物；目标4）确定哪些区域级SDOH（如果修改）预计将产生最大的减少在ADRD燃烧和成本的水平和不平等程度上。关于影响，我们将确定最有前途的 SDOH可以进行干预以改善Adrd Burnen和不平等。我们将进一步建立通过亚群来通往差异漏洞的途径。通过将估计值转化为人口健康指标，我们预计我们的项目将通过指导政策制定者的循证制定者产生巨大的翻译影响关于政策的决定，以更有效地减少美国人中ADRD的不平等现象的燃烧和不平等。