Cumulative socioeconomic exposures, cash transfer interventions, and later-life cognitive decline and dementia risk in a low-income region of South Africa

项目摘要 到2050年，75%的阿尔茨海默病和相关痴呆症（ADRD）病例将发生在低收入和中等收入人群中。 在非洲的一些地区，如南非农村，在ADRD研究中的代表性严重不足。存在一个临界 社会经济地位（SES）在低收入环境中ADRD病因学中作用的证据缺口，以及SES如何 可以通过干预措施来预防和/或延迟ADRD发作。我们的长期目标是让 设计性别平等的SES干预措施，以预防和/或延迟低收入环境中ADRD的发生。的 本提案的目的是确定SES如何影响ADRD风险，使用纵向暴露（家庭 资产、粮食安全和就业）以及随机和准随机现金转移风险 在南非农村的中晚期生活中积累起来的。我们的核心假设是， 暴露于有利的社会经济条件将防止ADRD，对男性有不同的影响 而妇女获得家庭一级的社会经济地位资源，这些资源可能没有在两性之间平等分配。为了验证这一 中心假设，我们将利用一个独特的机会，创建第一个纵向数据平台， 研究非洲的ADRD风险：我们将把2015-21年收集的高质量记忆和ADRD结果数据联系起来， 人口代表性“非洲的健康与老龄化：非洲INDEPTH社区的纵向研究， 南非”（HAALSI; N=5059）与自2000年以来在“Agincourt Health 和社会人口监测系统”（AHDSS;人口覆盖率为100%的人口普查）和HPTN 2011- 2015年对家庭进行现金转移的068项随机对照试验（两个HPTN中的N=863个家庭 068和HAALSI）。这三个数据集可以联系起来，因为AHDSS普查是 HAALSI和HPTN 068;我们在初步数据中证实了连锁的可行性。具体而言，我们的目标是：1） 确定中年到晚年累积家庭资产、就业和粮食安全的作用（2000-13; AHDSS）在记忆力下降和ADRD风险（2015-21; HAALSI）中的作用; 2）确定是否暴露于现金转移 干预影响记忆衰退和ADRD通过利用2a）随机现金转移在HPTN 068; 2b） 2c）扩大南非儿童抚养补助金 3）确定性别如何改变目标1和目标2中家庭一级SES暴露的影响。 2a.这项建议是创新的，因为研究人口的老年人，农村南非黑人成年人改善 ADRD研究中未充分研究的群体的代表性;我们对SES暴露的纵向评估， 14年改善了回顾性或单点测量的社会经济地位现状; HAALSI队列与随机对照现金转移试验和国家社会保障数据的联系 政策允许对收入和ADRD风险进行因果推断。这个提议是人生历程中的一个重大机遇 在快速老龄化的低收入人群中进行的研究，可以为ADRD病因和策略提供见解 在全球低收入环境中预防和/或延迟ADRD发作，在此研究之外几乎没有数据。

PROJECT SUMMARY By 2050, 75% of Alzheimer’s disease and related dementias (ADRD) cases will occur in low- and middle-income regions, like rural South Africa, which are severely under-represented in ADRD research. There is a critical evidence gap on the role of socioeconomic status (SES) in ADRD etiology in low-income settings, and how SES can best be targeted by interventions to prevent and/or delay ADRD onset. Our long-term goal is to inform the design of gender-equitable SES interventions to prevent and/or delay ADRD onset in low-income settings. The objective of this proposal is to identify how SES affects ADRD risk, using longitudinal exposures (household assets, food security, and employment) and randomized and quasi-randomized cash transfer exposures accumulated over time in mid-to-later-life in rural South Africa. Our central hypothesis is that greater cumulative exposure to advantageous socioeconomic conditions will protect against ADRD, with differential effects for men and women for household-level SES resources that may not be equally allocated between genders. To test this central hypothesis, we will leverage a unique opportunity to create one of the first longitudinal data platforms to study ADRD risk in Africa: we will link high-quality memory and ADRD outcome data collected from 2015-21 in the population-representative “Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa” (HAALSI; N=5059) to detailed SES exposure data collected since 2000 in the “Agincourt Health and Sociodemographic Surveillance System” (AHDSS; a census with 100% population coverage) and the HPTN 068 randomized controlled trial of cash transfers to households from 2011-15 (N=863 households in both HPTN 068 and HAALSI). These three datasets can be linked because the AHDSS census is the sampling frame for HAALSI and HPTN 068; we have confirmed linkage feasibility in our preliminary data. Specifically, we aim to: 1) Determine the roles of mid-to-later life cumulative household assets, employment, and food security (2000-13; AHDSS) in memory decline and ADRD risk (2015-21; HAALSI); 2) Determine whether exposure to cash transfer interventions affect memory decline and ADRD by leveraging 2a) randomized cash transfers in HPTN 068; 2b) expansion of the South African Old Age Pension for men; 2c) expansion of the South African Child Support Grant for mothers; and 3) Determine how gender modifies the effects of household-level SES exposures in Aims 1 & 2a. This proposal is innovative because the study population of older, rural Black South African adults improves representation of understudied groups in ADRD research; our longitudinal assessments of SES exposures over 14 years improve upon the status quo of SES measured retrospectively or at single points in time; and our linkage of the HAALSI cohort to a randomized controlled cash transfer trial and data on national social protection policies allows causal inference about income and ADRD risk. This proposal is a major opportunity for life course research in a rapidly aging, low-income population that can provide insights into ADRD etiology and strategies to prevent and/or delay ADRD onset in global low-income settings, where there is little data outside this study.