Examining racial segregation and underlying mechanisms related to VCID and incident stroke in the REGARDS study

随着人们年龄的增长，神经系统疾病的发展中存在种族不平等，这是一个重大的公共卫生问题。 虽然许多个体风险因素已被确定为预测血管对认知能力的贡献 损害和痴呆(VCID)以及中风，这些个别因素并不能完全解释斯塔克-布莱克- 这些结果中存在着白人差距。此外，塑造这些结果的结构性机制 人们对此知之甚少；尤其是限制机会的种族不平等社会环境背景 以及基于种族的资源。基于种族的学校隔离和种族居住隔离(RR)是 两个关键的结构性种族主义和歧视(SRD)因素，假设SRD在SRD如何 导致VCID和中风的不平等，但这方面的研究很少。在慢性疾病的交叉点 疾病、生命历程和空间流行病学为解决这一关键差距提供了独特的机会。这 这项研究利用了一项正在进行的大规模人口研究：地理和种族的原因 中风研究中的差异。问候是全国范围内超过30,000名成年人(45岁及以上)的样本 年龄较大的)，自我认同为非西班牙裔黑人的人和生活在中风带的人的样本过多。 建议的研究利用了VCID和中风的纵向评估在这个不同的 队列，以及与生物学、临床(例如，血管健康)相关的其他几个回顾和预期数据 条件)、行为(例如，健康行为)、社会文化(例如，社会支持、社会凝聚力、感知 歧视、社交网络)以及建筑和社会环境(BSE)因素 通过父母研究和两项研究收集的影响(个人、人际、社区和社会) 辅助研究。这些数据包括以州为基础和学校一级的学校隔离措施 学校参与者参加；每个学年的客观、县级教育质量衡量标准； 历史参与者住宅，将用于创建生命周期RRS暴露(中位数为51年) 拟议的研究；以及9项疯牛病措施(食品零售、公园、犯罪、商业体育活动、医疗保健、 社区SES、礼拜场所、社会参与和社会服务机构)超过40,000 中老年人的地理编码位置，将在拟议的研究中通过其他 地点和年份的数据。这项拟议的研究旨在：1)确定学校和学校之间的联系 VCID事件与晚年卒中事件的分离；教育质量的潜在中介作用； 并通过种族检查节制，2)检查事件VCID的生命过程中RR的关联 和事件卒中；并以种族考察适度，以及3)探索住宅的特点 邻里关系和人际关系因素可能在中老年RR和 事件VCID和中风；并检查种族的适度。这项最先进的研究将确定 通过SRD对VCID和中风的贡献，保护性复原力因素，以及干预点。

Racial inequity in the development of neurological conditions as people age is a major public health issue. While many individual risk factors have been identified as predictors of both vascular contributions to cognitive impairment and dementia (VCID), as well as stroke, these individual factors do not fully explain the stark Black- White disparities existing in these outcomes. Moreover, the structural mechanisms shaping these outcomes are far less understood; in particular, the racially unequal socio-environmental contexts that limit opportunities and resources based on race. Race-based school segregation and racial residential segregation (RRS) are two, critical, structural racism and discrimination (SRD) factors of hypothesized importance in how SRD contributes to inequalities in VCID and stroke, yet few studies exist in this area. At the intersection of chronic disease, life course, and spatial epidemiology emerges a unique opportunity to address this critical gap. This study leverages an ongoing, large-scale, population-based study: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study. REGARDS is a national sample of over 30,000 adults (45 years and older) with oversamples of persons self-identifying as non-Hispanic Black and people living in the stroke belt. The proposed study takes advantage of the longitudinal assessments of both VCID and stroke in this diverse cohort, and several other retrospective and prospective data related to biological, clinical (e.g., vascular health conditions), behavioral (e.g., health behaviors), socio-cultural (e.g., social support, social cohesion, perceived discrimination, social networks), and built and social environment (BSE) factors across multiple levels of influence (individual, interpersonal, community, and societal) collected through the parent study and two ancillary studies. These data include state-based and school-level school segregation measures for each school participants attended; objective, county-level educational quality measures for each year of schooling; historical participant residences that will be used to create a life course RRS exposure (median of 51 years) in the proposed study; and 9 BSE measures (food retail, parks, crime, commercial physical activity, healthcare, neighborhood SES, places of worship, social engagement, and social service institutions) for over 40,000 geocoded locations in middle and older ages that will be expanded upon in the proposed study via additional locations and years of data. The proposed study aims to: 1) Determine the association between school segregation on incident VCID and incident stroke later in life; the potential mediating role of educational quality; and to examine moderation by race, 2) Examine the association of RRS over the life course on incident VCID and incident stroke; and to examine moderation by race, and 3) Explore features of the residential neighborhood and interpersonal factors that may mediate the link between RRS in middle and older ages and incident VCID and stroke; and to examine moderation by race. This state-of-the-art study will identify pathways through which SRD contributes to VCID and stroke, the protective resilience factors, and points of intervention.