Alzheimer's disease and related dementias in a diverse cohort of Asian Americans

项目总结 超过四分之一的活到65岁的亚裔美国人有望被诊断为阿尔茨海默病 和相关痴呆症(ADRD)，然而亚裔美国人在ADRD研究中的代表性不足，以及 人们对亚裔人群风险的异质性知之甚少。在最全面的研究中 到目前为止，我们的研究小组发现亚裔美国人在ADRD发病率上存在显著差异 (菲律宾裔美国人的ADRD发生率比华裔美国人高27%)。尽管少校 不同群体之间ADRD风险的差异，所有亚裔种族的ADRD风险都低于非拉丁裔白人 (非拉丁裔白人的这一比例比亚裔美国人高25%)。这些发现对公共卫生具有重大意义 影响：将所有种族/民族的ADRD率降低到亚裔美国人的ADRD率将 美国每年预防19万例ADRD病例，但亚裔美国人减少的原因尚不清楚 ADRD发病率或亚裔族群不同的原因。解开这些谜团将有助于我们理解 在所有种族/民族背景的人中确定ADRD的决定因素，并帮助解决 关于亚裔美国人健康驱动因素的研究，亚裔美国人是美国增长最快的种族/民族群体 这项应用的目的是检查社会因素、心脏代谢健康和遗传因素 有助于降低亚裔美国人的ADRD风险和亚裔群体(菲律宾人)之间的风险差异 美国人、华裔美国人和日裔美国人)。建议进行这项研究的理由是 揭示亚裔美国人ADRD的风险和保护因素将揭示为什么亚裔美国人有 比其他种族/民族群体降低ADRD风险，并确定预防ADRD和减少ADRD的潜在战略 ADRD差异。我们收集了调查数据、社区信息和24年来的医疗记录 ~12,000名菲律宾、日本和华裔美国凯撒健康计划成员的记录将是 与非拉丁裔白人样本1：3匹配。此外，大约25%的样本具有基因数据 可用。这是最大、最多样化的亚裔美国人纵向样本，具有丰富的生物医学 和与ADRD相关的社交数据。我们的具体目标是：1)评估社会因素的作用 (世代地位、教育程度、收入、社区劣势指标、社区 2)评估心脏代谢健康的作用(糖尿病、 高血压、中风)对亚裔美国人ADRD风险的影响；3)决定基因血统和载脂蛋白E 在亚裔美国人中观察到的ADRD发病率的变异受基因型的影响。审视社会的角色， 心脏代谢和遗传因素对亚裔美国人和白人中ADRD风险的影响 将提供有价值的信息，防止所有种族/民族背景的人出现ADRD，并减少ADRD 差距。

PROJECT SUMMARY Over one in four Asian Americans who survive to age 65 can expect to be diagnosed with Alzheimer’s disease and related dementias (ADRD), yet Asian Americans are under-represented in ADRD research, and heterogeneity in risk across Asian ethnic groups is poorly understood. In the most comprehensive study to date, our research team discovered marked differences in ADRD incidence between Asian American ethnic groups (ADRD incidence was 27% higher in Filipino Americans than Chinese Americans). Despite the major differences in ADRD risk between groups, all Asian ethnic groups had lower ADRD risk than non-Latino whites (25% higher rate in non-Latino whites than Asian Americans). These findings have major public health implications: reducing ADRD rates in all racial/ethnic groups to rates observed in Asian Americans would prevent >190,000 ADRD cases annually in the U.S. Yet it is unknown why Asian Americans have lowered ADRD incidence or why Asian ethnic groups differ. Disentangling these puzzles will inform our understanding of the determinants of ADRD in people of all racial/ethnic backgrounds and help address the major gap in research on drivers of health in Asian Americans, the fastest growing racial/ethnic group in the U.S. The overall objective of this application is to examine how social factors, cardiometabolic health, and genetic factors contribute to lower ADRD risk in Asian Americans and differences in risk between Asian ethnic groups (Filipino Americans, Chinese Americans, and Japanese Americans). The rationale for the proposed research is that delineating risk and protective factors for ADRD in Asian Americans will unlock why Asian Americans have lower ADRD risk than other racial/ethnic groups and identify potential strategies to prevent ADRD and reduce ADRD disparities. We have assembled survey data, neighborhood information, and 24 years of medical records on ~12,000 Filipino, Japanese, and Chinese American Kaiser health plan members that will be matched 1:3 to a sample of non-Latino whites. Further, approximately 25% of the sample has genotype data available. This is the largest, most diverse longitudinal sample of Asian Americans with a rich set of biomedical and social data relevant to ADRD available. Our Specific Aims are: 1) evaluate the role of social factors (generational status, educational attainment, income, neighborhood disadvantage metrics, neighborhood ethnic enclaves) on ADRD risk in Asian Americans; 2) evaluate the role of cardiometabolic health (diabetes, hypertension, stroke) on ADRD risk in Asian Americans; 3) determine whether genetic ancestry and APOE genotype influence variation in ADRD incidence observed in Asian Americans. Examining the roles of social, cardiometabolic, and genetic factors on ADRD risk in a large, diverse cohort of Asian Americans and whites will provide valuable information to prevent ADRD in people of all racial/ethnic backgrounds and reduce ADRD disparities.