Multilevel Forms of Structural Racism and Racial Inequalities in ADRD Risk

项目总结/摘要 阿尔茨海默病和阿尔茨海默病相关痴呆症（AD/ADRD）在美国呈上升趋势。 States.据估计，到2025年，美国老年人的AD将增加40%。这种增长，沿着其 相关的经济，社会和健康负担，可能会产生不成比例的影响，因为黑人成年人 在美国的任何种族/民族群体中，痴呆症的发病率最高。 AD/ADRD的既定生物学风险因素发生率较高，包括高血压、糖尿病， 中风、炎症和生物老化。AD诊断、支出和负担的预期增长， 以及可能扩大的种族不平等，使调查早期风险因素成为当务之急。 AD/ADRD的发展和AD/ADRD中的种族不平等。种族主义的结构形式可能很重要 AD/ADRD风险中种族不平等的驱动因素。然而，这一领域的大部分研究都集中在下游， 因素，如面临压力和歧视，或某一时刻结构性种族主义的具体领域 及时缺少的是对结构性种族主义和与老龄化有关的健康不平等的纵向研究， 多种地理环境。此外，对公共卫生和政策干预如何 解决结构性种族主义问题可用于减少反歧视/反种族歧视方面的种族不平等。因果建模 技术提供了机会，以评估结构性干预措施对记录在案的不平等现象的影响， AD/ADRD的生物学风险因素。该项目的目的是双重的：1）创建 一个公共使用的，全面的数据存储库的多层次和重复的上下文措施的结构 种族主义; 2）结合现有的背景和个人层面，使用新的背景数据 来自国家青少年到成人健康纵向研究（Add Health）的纵向数据， 具体途径连接结构性种族主义和AD/ADRD的生物风险在中年早期美国成年人。 具体来说，我们将调查是否结构性种族主义在教育，住宅和刑事司法 背景独立并共同塑造AD/ADRD生物风险因素的黑白差异， 包括高血压、糖尿病、炎症、表观遗传衰老和两种新的AD/ADRD风险生物标志物 （神经丝光和总tau）。我们还将使用模拟模型来比较假设的 基于人口的政策变化和针对种族不平等的生物风险因素的干预措施 AD/ADRD风险。这项研究的结果将促进我们对结构性种族主义如何形成的理解 AD/ADRD风险在生命早期。模拟模型的结果也将为开发 人群水平，早期干预旨在减缓AD/ADRD风险的进展， 这些结果的不平等。

Project Summary/Abstract Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (AD/ADRD) are on the rise in the United States. Estimates project a 40% increase in AD among older Americans by 2025. This increase, along with its associated economic, social, and health burdens, are likely to have disproportionate impacts, as Black adults have the highest incidence of dementia of any racial/ethnic group in the U.S. Moreover, Black Americans experience higher rates of established biological risk factors for AD/ADRD, including hypertension, diabetes, stroke, inflammation, and biological aging. The expected growth in AD diagnoses, expenditures, and burdens, as well as potentially widening racial inequalities, make it imperative to investigate early risk factors for the development of AD/ADRD and racial inequalities in AD/ADRD. Structural forms of racism are likely important drivers of racial inequalities in AD/ADRD risk. Yet, much of the research in this area focuses on downstream factors, such as exposure to stressors and discrimination, or specific domains of structural racism at one point in time. Missing are longitudinal studies of structural racism and aging-related health inequalities across multiple geographic contexts. Further, there is limited knowledge of how public health and policy interventions addressing structural racism can be utilized to reduce racial inequalities in AD/ADRD. Causal modeling techniques provide opportunities to assess the impact of structural interventions on documented inequalities in biological risk factors for AD/ADRD using observational data. The purpose of this project is twofold: 1) to create a public-use, comprehensive data repository of multilevel and repeated contextual measures of structural racism; and 2) use the new contextual data in combination with existing contextual and individual-level longitudinal data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to examine specific pathways linking structural racism and AD/ADRD biological risk among early midlife U.S. adults. Specifically, we will investigate whether structural racism across educational, residential, and criminal justice contexts independently and jointly shape Black-White disparities in biological risk factors for AD/ADRD, including hypertension, diabetes, inflammation, epigenetic aging, and two novel biomarkers of AD/ADRD risk (neurofilament light and total tau). We will also use simulation models to compare the effects of hypothetical population-based policy changes and targeted interventions on racial inequalities in biological risk factors of AD/ADRD risk. Findings from this study will advance our understanding of how structural racism shapes AD/ADRD risk early in the life course. Results from simulation models will also inform the development of population-level, early interventions aimed to slow the progression of AD/ADRD risk and reduce health inequalities in these outcomes.