Objective and Perceived Neighborhood Characteristics and Cognitive Decline

描述(由调查人员提供)：社区的社会、经济、人口和建筑特征已被证明影响健康结果，如死亡率、肥胖症、心血管疾病和抑郁症，独立于个人因素。最近的文献表明，个人所在地区的邻里社会经济地位(NSE)与认知功能相关，与个人因素无关。然而，到目前为止，还没有研究在具有全国代表性的样本中检查纵向关系。此外，研究集中在没有检查其他客观的与健康相关的社区特征和感知的社区特征的NSE，没有考虑其他敏感的晚年认知结果，如认知障碍，也没有解决例如基于健康状况的社区选择是否可能偏离结果的客观。该项目将填补现有研究的空白，方法是开发一个国家客观邻里特征数据库，将这些数据与健康和退休研究(HRS)中具有全国代表性的老年人样本中评估的认知功能纵向数据联系起来，并研究客观和感知的邻里特征与认知功能随时间的关系。这项研究还将检查一系列潜在的中介因素，包括压力的生物标记物，以及可能影响邻居影响认知结果的机制路径的血管、行为和心理社会因素。它还将根据社会人口学和遗传特征确定最容易受到邻里效应影响的亚群，并测试我们的发现对选择偏倚方法的敏感性。我们将建立一个客观的邻里测量数据库，包括NSE、种族/民族隔离和组成、城市扩张和食物环境，并将其与HRS提供的社区认知功能和主观评级的个人数据以及血管事件临床诊断的医疗保险数据相结合。结构方程模型将检验邻里效应的独立关联、中介和效应修正。一种名为省略变量分析的创新统计技术将解决个人可能根据健康状况有选择地进入不同社区的可能性，倾向分数匹配将用于减少在确定社区特征对认知结果的影响方面的潜在偏见。这项研究可以阐明可作为干预目标的背景特征，并在预防认知衰退和损害的努力方面产生比侧重于个人因素的干预更大范围的变化。中介分析将确定潜在的生物、血管、行为和心理社会机制，以确定更接近的干预目标，以缓冲生活在较低质量社区的影响。确定弱势群体将更有效地将公共卫生干预重点放在高危群体上。 公共卫生相关性：拟议的研究旨在为临床医生、公共卫生官员和政策制定者提供信息，说明个人所处的建筑、人口、经济和社会环境的客观和感知特征是否纵向上与认知功能恶化、认知障碍和认知下降的风险有关。这项研究将阐明血管、行为和心理社会因素以及应激的生物标记物是否可以解释这些关系，并确定可能最容易受到邻居影响认知结果的社会人口学和遗传亚群。随着患痴呆症风险的老年人比例的增加，我们的研究可以阐明影响这一风险的背景特征，从而确定可修改的干预目标，并在努力防止认知衰退和损害方面取得更大规模的改善，而不是仅关注个人因素的干预。

DESCRIPTION (provided by investigator): Neighborhood social, economic, demographic, and built characteristics have been shown to influence health outcomes such as mortality, obesity, cardiovascular disease, and depression, independent of individual factors. Recent literature suggests that the neighborhood socioeconomic status (NSES) of the area in which individuals live is correlated with cognitive functioning, independent of individual factors. However, no studies to date have examined longitudinal relationships in a nationally representative sample. In addition, studies have focused on NSES without examination of other objective health-relevant neighborhood characteristics and perceived neighborhood characteristics, have not considered other sensitive late-life cognitive outcomes such as cognitive impairment, and have not addressed whether selection into neighborhoods, based on health status for example, may bias results Objective. This project will fill gaps in existing research by developing a national database of objective neighborhood characteristics, linking these data with longitudinal data on cognitive function assessed in a nationally representative sample of older adults in the Health and Retirement Study (HRS) assessed over 22 years (1992-2014), and examining the relationship between both objective and perceived neighborhood characteristics and cognitive function over time. This study will also examine a host of potential mediators including biomarkers of stress, and vascular, behavioral, and psychosocial factors that may inform mechanistic pathways by which neighborhoods influence cognitive outcomes. It will also identify subgroups that are most vulnerable to neighborhood effects based on sociodemographic and genetic characteristics, and test the sensitivity of our findings to selection bias Methods. We will develop a database of objective neighborhood measures including NSES, racial/ethnic segregation and composition, urban sprawl, and food environment, and integrate it with individual data on cognitive function and subjective ratings of neighborhoods from the HRS and with Medicare data on clinical diagnoses of vascular events. Structural equation models will examine independent associations, mediation, and effect modification of neighborhood effects. An innovative statistical technique called omitted variable analysis will address the potential that individuals may selectively move into differing neighborhoods by health status and propensity score matching will be used to reduce potential biases in identifying the effects of neighborhood characteristics on cognitive outcomes Implications. This research can shed light on contextual characteristics that may serve as modifiable targets for interventions, and yield larger-scale changes in the effort to prevent cognitive decline and impairment than interventions that focus on individual factors. Mediation analyses will identify underlying biological, vascular, behavioral, and psychosocial mechanisms to pinpoint more proximal intervention targets to buffer against the effects of living in a lower quality neighborhood. Identification of vulnerable subgroups will focus public health interventions more efficiently on at-risk groups. PUBLIC HEALTH RELEVANCE: The proposed research aims to provide clinicians, public health officials, and policymakers with information on whether objective and perceived characteristics of the built, demographic, economic, and social environments in which individuals live are longitudinally related to risk for worse cognitive function, cognitive impairment, and steeper cognitive decline. This research will clarify whether vascular, behavioral, and psychosocial factors and biological markers of stress may explain these relationships and also identify sociodemographic and genetic subgroups that may be most vulnerable to neighborhood influences on cognitive outcomes. As the proportion of older adults at risk for dementia grows, our research can shed light on contextual characteristics that influence this risk, thus identifying modifiable targets for intervention and yielding larger-scale improvements in the effort to prevent cognitive decline and impairment than interventions that focus on individual factors alone.