Social Mechanisms Underlying Sex/Gender Inequalities in Alzheimers Disease: An Intersectionality Approach

阿尔茨海默病中性别不平等的社会机制：交叉方法

• 批准号: 10507032
• 负责人: Justina Frances Avila-Rieger
• 金额: $ 13.08万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10507032
• 关键词: Affect; Age; Aging; Alzheimer' s Disease; Alzheimer' s disease pathology; Alzheimer' s disease risk; Alzheimer’s disease biomarker; Biological; Black race; Categories; Cognitive; Cognitive aging; Communities; Complement; Conflict (Psychology); Data; Disadvantaged; Discrimination; Disease Outcome; Economics; Elderly; Evolution; Exposure to; Foundations; Gender; Gonadal Steroid Hormones; Health; Health and Retirement Study; Heterogeneity; Human; Impaired cognition; Individual; Inequality; Intervention; Learning; Link; Longitudinal Studies; Measures; Methods; Minority; Nature; Outcome; Pattern; Persons; Plant Roots; Politics; Process; Public Health; Race; Reasons for Geographic And Racial Differences in Stroke; Research; Research Personnel; Research Training; Resources; Role; Sexism; Shapes; Social Identification; Statistical Methods; Structural Models; Structural Racism; Techniques; Time; Training; Washington; Woman; Work; black men; black women; career; cognitive performance; cognitive reserve; cognitive testing; cohort; experience; gender difference; gender disparity; health disparity; health inequalities; health outcome disparity; improved; interest; intersectionality; men; offspring; performance tests; prevent; programs; public health research; racial and ethnic disparities; racism; research study; sex; social; social health determinants; social structure; socioeconomics

PROJECT SUMMARY/ABSTRACT Alzheimer’s disease (AD) is a major public health burden that disproportionately affects women. Women in the U.S. have experienced structural barriers, which prevent them from accessing health enhancing opportunities and resources, that may have a negative impact on their AD risk. For Black women, the societal disadvantages associated with being a woman are further compounded by those associated with being Black. Little has been done to understand the link between these structural inequalities and sex/gender differences in AD. Differences between men and women are assumed to be primarily biological in nature (e.g., due to effects of sex-steroid hormones) and socially driven heterogeneity among women has been largely ignored. To move the field forward, researchers interested in sex/gender differences in AD must identify and understand the structural drivers of cognitive health inequalities between men and women. The scientific objective of this research plan is to determine whether structural determinants influence sex/gender inequalities in AD outcomes. This project applies an intersectionality approach that examines how multiple experiences of structural-level discrimination and inequality (i.e., structural sexism, structural racism) overlap and interact to produce disparate cognitive health outcomes among non-Latinx Black and White women and men. Aim 1 (K99) focuses on determining the extent to which state-level structural sexism and racism influences cognitive trajectories among sex/gender-by- race groups. Aim 2 (R00) proposes to investigate whether sex/gender inequalities in cognitive reserve varies across levels of structural sexism and racism exposure. This proposal leverages cognitive trajectory and AD- biomarker data from five cohort and nationally representative longitudinal studies: Washington Heights-Inwood Community Aging Project (WHICAP), Offspring study, Minority Aging Research Study (MARS), Health and Retirement Study (HRS), and Reasons for Geographic and Racial Differences in Stroke (REGARDS). State- level indicators of structural sexism and racism will be used. State-of-the-art statistical methods will be employed to examine intersectionality that have been previously used in public health research, but that have not yet been applied to longitudinal cognitive aging outcomes. This research plan is complemented by a training plan that builds on the candidate’s background in cognitive aging, health disparities, and advanced statistical methods and includes new training in (1) cutting-edge analytic intersectionality techniques, (2) measuring and modeling structural determinants of health, (3) sex/gender differences in AD-biomarkers, and (4) causal inference methods. The combined research and training plans will prepare the applicant for a successful independent research career focused on identifying macro-social and biological determinants of sex/gender inequalities in AD.

项目总结/摘要 阿尔茨海默氏病（AD）是一个主要的公共卫生负担，对妇女的影响不成比例。妇女 美国经历了结构性障碍，使他们无法获得增进健康的机会 和资源，这可能会对他们的AD风险产生负面影响。对于黑人女性来说， 与身为女性相关的问题，再加上与身为黑人相关的问题，更是雪上加霜。很少 这样做是为了了解这些结构性不平等和AD中的性别/性别差异之间的联系。差异 男性和女性之间的关系被认为主要是生物学性质的（例如，由于性类固醇的影响 激素）和社会驱动的妇女异质性在很大程度上被忽视。为了推动这个领域的发展， 对AD中的性别/性别差异感兴趣的研究人员必须识别和理解AD的结构驱动因素， 男性和女性之间的认知健康不平等。这项研究计划的科学目标是 确定结构性决定因素是否影响AD结果中的性别/性别不平等。这个项目 采用交叉性方法，研究结构层面歧视的多重经历 和不平等（即，结构性性别歧视、结构性种族主义）重叠并相互作用，产生不同的认知 非拉丁裔黑人和白色女性和男性的健康结果。目标1（K99）侧重于确定 国家一级的结构性性别歧视和种族主义在多大程度上影响了按性别分列的 种族群体。目标2（R 00）建议调查认知储备中的性别/性别不平等是否不同 结构性性别歧视和种族主义暴露的水平。该提案利用认知轨迹和AD- 来自五项队列和全国代表性纵向研究的生物标志物数据：华盛顿Heights-Inwood 社区老龄化项目（WHICAP），后代研究，少数民族老龄化研究（MARS），健康和 退休研究（HRS）和中风的地理和种族差异的原因（REGARDS）。说明─ 将使用结构性性别歧视和种族主义的水平指标。将采用最先进的统计方法 检查以前在公共卫生研究中使用过的交叉性，但尚未被 应用于纵向认知老化结果。该研究计划由培训计划补充， 基于候选人在认知老化，健康差异和先进统计方法方面的背景 包括（1）尖端分析交叉性技术，（2）测量和建模 健康的结构决定因素，（3）AD生物标志物的性别/性别差异，以及（4）因果推断 方法.结合研究和培训计划将准备申请人成功的独立 研究职业生涯侧重于确定宏观社会和生物决定因素的性/性别不平等， AD.