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

摘要 NIA呼吁进行社会科学和以社区为基础的研究，以澄清癌症的风险和保护因素 阿尔茨海默病和相关痴呆症(ADRD)，特别是在 受到不成比例的影响。地方，包括居住的社区和地区/出生地，有 一直与ADRD、中风和认知功能受损相关。然而，目前还不清楚 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了 不健康的人进入贫困地区。这项研究的目标是产生第一个准实验 了解邻里社会经济剥夺对ADRD及其血管影响的证据 风险因素。我们利用独特的自然实验，克服了方法论上的挑战 先前关于邻里关系对ADRD影响的文献。从1986年到1998年，丹麦政府积极 以近乎随机(“准随机”)的方式将大约76,000名难民分散到全国各地 在大城市避免过度拥挤的时尚。这一队列包括近12,000个人，他们生活到 在30年的随访期内，丹麦人的年龄至少为60岁。超过90%的家庭同意参加 计划，创建一个自然实验，在这个实验中，这些人被准随机分配到 有着不同程度贫困的社区。我们将使用跨越30年的独特数据，从 丹麦的人口和临床登记簿，提供有关社会人口学、临床遭遇、 并为所有丹麦居民开出处方。我们确定了ADRD的病例及其血管危险因素 通过使用ICD代码和临床登记簿中的处方数据的验证技术进行种族多样化的队列研究。我们 我已经成功地将这些注册表与详细的地理编码数据源相关联，这些数据源有八个度量标准 社区的社会经济贫困。在目标1中，我们的目标是测试邻里关系的假设 剥夺会增加ADRD的发生率和晚年的死亡率。在目标2中，我们将研究 邻里剥夺对ADRD血管危险因素的影响，包括发生的高度流行的情况 横跨整个人生历程。在目标3中，我们将确定易受伤害的亚群，他们的ADRD和 利用大样本量的优势，血管风险因素对邻域剥夺的反应有所不同 并提供所有受试者的完整注册数据。我们将同时使用假设驱动和假设- 生成统计技术，包括允许更复杂的创新机器学习方法 和稳健的子群识别。这将使未来的干预措施能够针对最脆弱的人量身定做 个人。总体而言，这项研究的预期结果是提供关于以下因素影响的严格证据 关于ADRD和血管危险因素的邻里特征，克服 以前的工作。这将直接为临床、社区和政策战略的发展提供信息，以解决 高危弱势人群中ADRD的邻里决定因素。

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 and mortality 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.