Using a Natural Experiment to Evaluate the Long-Term Effects of Neighborhood Deprivation on Alzheimer's Disease and Vascular Risk Factors

利用自然实验评估邻里剥夺对阿尔茨海默病和血管危险因素的长期影响

基本信息

批准号：
10988546
负责人：
Rita Hamad
金额：
$ 22.7万
依托单位：
HARVARD SCHOOL OF PUBLIC HEALTH
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-05-01 至 2025-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10988546
关键词：
Using Natural Experiment Evaluate Long

项目摘要

ABSTRACT The NIA has called for social science and community-based studies to clarify risk and protective factors for Alzheimer's disease and related dementias (ADRD), particularly among racial minorities who are disproportionately affected. Place, including both neighborhood of residence and region/state of birth, has consistently been correlated with ADRD, stroke, and impaired cognitive function. Yet it is unclear whether modifiable mechanisms explain this association, or whether the association is merely due to the selection of unhealthy individuals into poor regions. The goal of this study is to produce the first quasi-experimental evidence to understand the influence of neighborhood socioeconomic deprivation on ADRD and its vascular risk factors. We take advantage of a unique natural experiment, overcoming methodological challenges in the previous literature on neighborhood effects on ADRD. From 1986 to 1998, the Danish government actively dispersed roughly 76,000 incoming refugees across the country in a nearly randomized (“quasi-random”) fashion to avoid over-crowding in major cities. This cohort includes nearly 12,000 individuals who lived until at least age 60 in Denmark during the 30-year follow-up. Over 90% of families agreed to participate in the program, creating a natural experiment in which these individuals were quasi-randomly assigned to neighborhoods with different levels of deprivation. We will employ unique data spanning over 30 years from Denmark's population and clinical registers, which provide data on sociodemographics, clinical encounters, and prescriptions for all Danish residents. We identify cases of ADRD and its vascular risk factors among this racially diverse cohort via validated techniques using ICD codes and prescription data in clinical registers. We have successfully linked these registers to detailed geocoded data sources on eight measures of neighborhood socioeconomic deprivation. In Aim 1, our goal is to test the hypothesis that neighborhood deprivation increases the incidence of ADRD later in life. In Aim 2, we will examine the effects of neighborhood deprivation on vascular risk factors for ADRD, including highly prevalent conditions that occur across the life course. In Aim 3, we will identify vulnerable subgroups whose development of ADRD and vascular risk factors differs in response to neighborhood deprivation, taking advantage of the large sample size and complete register data available on all subjects. We will employ both hypothesis-driven and hypothesis-generating statistical techniques, including innovative machine learning methods that allow for more complex and robust subgroup identification. This will enable future interventions to be tailored to the most vulnerable individuals. Overall, the expected outcome of this research is to produce rigorous evidence on the effects of neighborhood characteristics on ADRD and vascular risk factors, overcoming the methodological challenges in previous work. This will directly inform the development of clinical, community, and policy strategies to address the neighborhood determinants of ADRD among vulnerable populations who are most at-risk.

抽象的 NIA 呼吁进行社会科学和基于社区的研究，以澄清风险和保护因素阿尔茨海默氏病和相关痴呆症 (ADRD)，特别是在少数族裔中地点，包括居住地附近和出生地区/州，受到了不成比例的影响。但尚不清楚是否可修改的机制解释了这种关联，或者这种关联是否仅仅是由于选择这项研究的目标是产生第一个准实验。了解社会经济邻里剥夺对 ADRD 及其血管的影响的证据我们利用独特的自然实验，克服了方法上的挑战。先前关于ADRD 邻里影响的文献从1986 年到1998 年，丹麦政府积极进行研究。以近乎随机（“准随机”）的方式将大约 76,000 名入境难民分散到全国各地该群体包括近 12,000 名生活在 20 年前的人。在 30 年的随访期间，丹麦至少 60 岁的家庭同意参加该项目。程序，创建一个自然实验，其中这些人被准随机分配到我们将使用 30 多年来的独特数据来研究具有不同贫困程度的社区。丹麦的人口和临床登记册，提供有关社会人口统计、临床情况、我们确定了 ADRD 病例及其血管危险因素。我们通过使用 ICD 代码和临床登记中的处方数据的经过验证的技术来确定种族多样化的队列。已成功将这些寄存器链接到有关八项措施的详细地理编码数据源邻里社会剥夺在目标 1 中，我们的目标是检验邻里社会剥夺的假设。剥夺会增加以后生活中 ADRD 的发生率。在目标 2 中，我们将研究邻里关系的影响。剥夺 ADRD 的血管危险因素，包括一生中发生的高度普遍的疾病在目标 3 中，我们将确定出现 ADRD 的弱势亚群和血管危险因素。利用大样本量和完整的优势，对邻里剥夺的反应有所不同我们将采用假设驱动和假设生成的方式注册所有主题的可用数据。统计技术，包括创新的机器学习方法，可以实现更复杂、更稳健的计算亚组识别。这将使未来的干预措施能够针对最脆弱的个体。总体而言，这项研究的预期结果是为邻里关系的影响提供严格的证据 ADRD和血管危险因素的特点，克服了以前的方法学挑战这将直接为解决该问题的临床、社区和政策战略的制定提供信息。风险最高的弱势群体中 ADRD 的邻里决定因素。

项目成果

期刊论文数量（5）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Immigrants to the United States contribute to society: Here are 3 ways to support their transition.

美国移民为社会做出贡献：以下是支持他们过渡的 3 种方法。

DOI：
10.1093/haschl/qxae019
发表时间：
2024
期刊：
Health affairs scholar
影响因子：
0
作者：
Hamad,Rita
通讯作者：
Hamad,Rita

Neighborhood disadvantage and the risk of dementia and mortality among refugees to Denmark: A quasi-experimental study.

DOI：
10.1016/j.ssmph.2022.101312
发表时间：
2023-03
期刊：
SSM-POPULATION HEALTH
影响因子：
4.7
作者：
Kim, Min Hee;Foverskov, Else;Froslev, Trine;White, Justin S.;Glymour, M. Maria;Hainmueller, Jens;Pedersen, Lars;Sorensen, Henrik T.;Hamad, Rita
通讯作者：
Hamad, Rita

Natural and Unnatural Experiments in Epidemiology.