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

随着年龄的增长，神经系统疾病的发展中种族不平等是一个主要的公共卫生问题。 虽然许多个体风险因素已被确定为血管对认知功能和认知功能的预测因子， 损伤和痴呆（VCID），以及中风，这些个别因素并不能完全解释鲜明的黑色- 白色差异存在于这些结果中。此外，形成这些结果的结构性机制 尤其是，种族不平等的社会环境限制了机会 和资源。基于种族的学校隔离和种族居住隔离（RRS） 两个关键的，结构性种族主义和歧视（SRD）因素的假设重要性， 导致VCID和中风的不平等，但这方面的研究很少。在慢性病的交叉点 疾病、生命过程和空间流行病学为解决这一关键差距提供了一个独特的机会。这 一项研究利用了一项正在进行的、大规模的、基于人群的研究： 卒中差异（REGARDS）研究。REGARDS是一个全国性的样本，超过30，000名成年人（45岁， 老年人）与自认为是非西班牙裔黑人和生活在中风带的人的过度样本。 这项研究利用了VCID和中风的纵向评估， 队列以及与生物学，临床（例如，血管健康 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，知觉 歧视，社交网络），以及建筑和社会环境（BSE）因素在多个层次的 影响（个人，人际，社区和社会）收集通过父母的研究和两个 辅助研究。这些数据包括各州和学校一级的学校隔离措施， 入学人数;每学年客观的县级教育质量衡量标准; 将用于创建生命过程RRS暴露（中位数为51年）的历史参与者住所， 拟议的研究;和9个疯牛病措施（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）， 中老年人的地理编码位置，将在拟议的研究中通过额外的 地点和年份的数据。本研究的目的是：1）确定学校之间的关联 VCID事件与日后卒中事件的分离;教育质量的潜在中介作用; 并检查种族的适度性，2）检查RRS在生命过程中对事件VCID的关联 和事件中风;并检查适度的种族，和3）探索功能的住宅 邻里和人际因素，可能介导的联系RRS在中年和老年人， 以及按种族研究节制程度。这项最先进的研究将确定 SRD通过哪些因素导致VCID和中风、保护性弹性因素和干预点。

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.