Racial Disparities in Alzheimer's Disease and Related Dementias: The Role of School Segregation and Experiences of Discrimination

阿尔茨海默病和相关痴呆症的种族差异：学校隔离的作用和歧视经历

• 批准号: 10606362
• 负责人: Sirena Celeste Gutierrez
• 金额: $ 4.72万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-01 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10606362
• 关键词: Address; Adult; Affect; African American population; Age; Aging; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Black Populations; Black race; Chronic; Cognitive; Cognitive aging; Competence; Dementia; Desegregation; Discrimination; Disparity; Education; Elderly; Employment Opportunities; Environment; Epidemiologic Methods; Epidemiologist; Ethnic Population; Event; Exposure to; Funding; Future; Goals; Health; Hypertension; Impaired cognition; Income; Individual; Inequity; Intervention; Life; Life Cycle Stages; Life Experience; Link; Longitudinal cohort; Measures; Mediator; Mentorship; Methodology; Methods; Neighborhoods; Not Hispanic or Latino; Occupational; Outcome; Participant; Pathway interactions; Patient Self-Report; Physiological; Policies; Population; Population Heterogeneity; Population Intervention; Public Health; Race; Racial Segregation; Records; Research; Research Personnel; Research Support; Risk; Risk Factors; Role; Schools; Scientist; Shapes; Social Environment; Socioeconomic Status; Structural Racism; System; Time; Training; United States; Work; aged; aging brain; biological adaptation to stress; brain health; cardiovascular risk factor; career; cognitive function; cohort; dementia risk; early childhood; educational atmosphere; experience; first grade; health care availability; health inequalities; healthy aging; high risk; improved; insight; middle age; mild cognitive impairment; ninth grade; perceived discrimination; poor health outcome; prevent; racial difference; racial disparity; racial population; racism; residential segregation; school environment; segregation; sixth grade; skills; social factors; socioeconomics; stressor; twelfth grade

PROJECT SUMMARY Alzheimer’s disease and related dementias (ADRDs) are a major public health burden and disproportionately affect Black individuals. Although socioeconomic and cardiovascular risk factors partially account for this, experiences of structural (e.g. school segregation) and interpersonal racism (e.g. discrimination) could be important drivers of cognitive inequities. The racialized experience of school segregation can have pervasive effects on sustained discriminatory events and poor health outcomes because of stress-response activation, in addition to decreased socioeconomic opportunities, which may contribute to increased ADRDs risk. Limited studies on the impact of school segregation on late-life cognitive outcomes have produced mixed findings and did not consider incident dementia risk. Additionally, prior studies have not considered mid or late-life mediators of the association between school segregation or quantified the timing of school segregation. Thus, the rationale for the proposed research is to delineate the association of school segregation and resulting experiences of interpersonal discrimination on ADRDs risk to explain why Black individuals have a higher ADRDs burden than other racial and ethnic groups and to identify potential strategies to prevent ADRDs and reduce ADRDs disparities (e.g. organization and occupational policies to reduce racism). The analysis will leverage the Study of Healthy Aging in African Americans and Kaiser Healthy Aging and Diverse Life Experiences, NIA-funded longitudinal cohorts of older adult populations in the United States. The overall objective of this application is to examine the effect of school segregation on ADRDs inequities among older Black and White adults (ages 50-89). This project will also address how experiences of discrimination across the lifecourse impact cognitive trajectories and ADRDs risk. Specifically, this study will evaluate the association between attendance at a racially segregated school on cognitive decline and ADRDs risk among Black individuals (Aim 1) and evaluate the role of everyday and major life discrimination as mediators of this association (Aim 2). Finally, the proposed study will estimate the extent to which racial differences in cognitive decline and ADRDs risk are contributed by differential exposure to school segregation, everyday discrimination, and major life discrimination among Black and White individuals (Aim 3). Examining the roles of sociocontextual factors on ADRDs risk in a large, diverse cohort of Black and White individuals will provide valuable insight into the sustained effects of structural and interpersonal racism on ADRDs risk and will inform population interventions to reduce ADRDs inequities including the targeting of intermediate or proximal mechanisms (e.g. improving neighborhood and educational quality, enhancing access to additional income and employment opportunities). The proposed training, guided by an exemplary mentorship team, will enhance the applicant’s methodological skills, research competency, and content expertise needed for her career as a future independent researcher in ADRDs focused on strategies to reduce racial inequities.

项目概要 阿尔茨海默氏病和相关痴呆症 (ADRD) 是一项重大的公共卫生负担，并且不成比例地 尽管社会经济和心血管风险因素部分解释了这一点， 结构性（例如学校隔离）和人际种族主义（例如歧视）的经历可能是 学校隔离的种族化经历可能是造成认知不平等的重要因素。 由于压力反应激活而对持续的歧视事件和不良健康结果产生影响， 除了社会经济机会减少之外，这可能会导致 ADRD 风险增加。 关于学校隔离对晚年认知结果影响的研究得出了不同的结果， 另外，之前的研究没有考虑中年或晚年的痴呆风险。 学校隔离之间关联的中介因素或量化学校隔离的时间因此， 拟议研究的基本原理是描绘学校隔离与由此产生的社会隔离之间的关系 人际歧视对 ADRD 风险的经历可以解释为什么黑人个体的 ADRD 风险更高 ADRD 的负担高于其他种族和族裔群体，并确定预防 ADRD 和的潜在策略 减少 ADRD 差异（例如减少种族主义的组织和职业政策）。 利用非裔美国人健康老龄化研究和凯撒健康老龄化和多元化生活 经验，NIA 资助的美国老年人口纵向队列。 该应用程序的目的是研究学校隔离对老年人 ADRD 不平等的影响 该项目还将探讨黑人和白人成年人（50-89 岁）的歧视经历。 具体来说，本研究将评估生命历程对认知轨迹和 ADRD 风险的影响。 就读种族隔离学校导致黑人认知能力下降和 ADRD 风险之间的关系 个体（目标 1），并评估日常生活和主要生活中的歧视作为这一因素的中介者的作用 最后，拟议的研究将估计认知方面的种族差异程度。 下降和 ADRD 风险是由每天不同程度的学校隔离造成的 歧视，以及黑人和白人之间的重大生活歧视（目标 3）。 在大量、多样化的黑人和白人群体中，社会背景因素对 ADRD 风险的影响将提供 关于结构性和人际种族主义对 ADRD 风险的持续影响的宝贵见解，并将提供信息 减少 ADRD 不平等的人口干预措施，包括针对中间或近端人群 机制（例如改善社区和教育质量、增加获得额外收入和 就业机会）。拟议的培训由模范导师团队指导，将增强 申请人的职业生涯所需的方法论技能、研究能力和内容专业知识 ADRD 未来的独立研究员专注于减少种族不平等的策略。