A binational study to understand dementia risk and disparity among Mexican Americans: The role of Migration and Social Determinants

一项旨在了解墨西哥裔美国人痴呆症风险和差异的两国研究：移民和社会决定因素的作用

• 批准号: 9968663
• 负责人: Medellena Maria Glymour
• 金额: $ 135.1万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-06-15 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9968663
• 关键词: binational; study; understand; dementia; risk

Summary- from original application-no change Little is known about dementia disparities for Mexican Americans, who comprise the majority of United States (US) Latinos. Mexican Americans experience substantial social disadvantages compared with non-Latino whites in the US, including lower education, lower socioeconomic status, and migration- related stressors. Despite sustained disadvantage, the limited available evidence suggests that Mexican Americans exhibit similar rates of dementia as non-Latino whites. Unexpected health advantages of Mexican Americans have also been observed for many other health outcomes. Selective migration, both of healthy people from Mexico to the US and return migration of unhealthy adults back to Mexico, is a leading explanation for the Mexican American health advantage. Several known risk factors for dementia are also predictors of migration from Mexico to the US. However, no work has quantified selective migration and the bias it introduces to the comparison between Mexican American and non-Latino whites with respect to dementia risk. Therefore, it is unknown whether a dementia risk disparity exists for Mexican Americans after correcting for selective migration. In this study, we propose to combine data from two harmonized, nationally representative cohorts of adults aged 50+: the US Health and Retirement Study (HRS, n=26,690, including 2,452 Mexican Americans) and the Mexican Health and Aging Study (MHAS, n=13,798). These cohorts include harmonized longitudinal cognitive measures that are robustly linked to dementia risk. Accounting for selective migration is almost impossible with US-only data. Combining data from a Mexico- and a US- based cohort, we include both migrants and non-migrants, allowing us to test whether there are disparities in dementia risk and major factors driving dementia risk in Mexican Americans after accounting for migration patterns. This binational study will allow us to (Aim 1) quantify selective migration from Mexico to the US and return migration to Mexico as a function of established childhood and adult dementia risk factors that may influence migration patterns. We will then create a "propensity to migrate" score. This score will adopt a new approach to evaluating the contribution of social factors to selective migration bias, based on evaluating relative social position within Mexican Americans born in Mexico, US-born Mexican Americans, and US-born non-Latino whites, rather than directly comparing people with the same absolute social position. Using this score to account for selection bias, we will show the magnitude of (Aim 2) differences in dementia risk comparing Mexican Americans to US non-Latino whites and (Aim 3) differences in dementia risk associated with migration to the US, compared to people who remained in Mexico. The link between socioeconomic factors and health in Mexican Americans is uncertain, so we will (Aim 4) identify effects of education, household and neighborhood disadvantage, and discrimination on dementia risk of Mexican Americans, accounting for selective migration. This study will provide critical information about dementia risk in this growing US population and other disadvantaged or immigrant groups.

摘要-与原始申请相同-无变化 关于墨西哥裔美国人的痴呆症差异知之甚少，他们占美国人口的大多数。 美国拉丁美洲人。墨西哥裔美国人经历了实质性的社会劣势相比， 美国的非拉丁裔白人，包括较低的教育水平，较低的社会经济地位和移民- 相关的压力。 尽管持续的劣势，有限的可用证据表明，墨西哥裔美国人表现出 与非拉丁裔白人的痴呆率相似。墨西哥裔美国人意想不到的健康优势 在许多其他健康结果中也观察到了这一点。选择性迁移，健康人 从墨西哥到美国，以及不健康的成年人返回墨西哥，是一个主要的解释。 墨西哥裔美国人的健康优势几个已知的痴呆症风险因素也是预测因素 从墨西哥移民到美国。然而，没有工作量化选择性移民和偏见， 介绍了墨西哥裔美国人和非拉丁裔白人之间的痴呆症的比较 风险因此，目前尚不清楚墨西哥裔美国人是否存在痴呆症风险差异， 纠正选择性迁移。在这项研究中，我们建议联合收割机数据从两个协调， 50岁以上成年人的全国代表性队列：美国健康和退休研究（HRS， n= 26，690，包括2，452名墨西哥裔美国人）和墨西哥健康与衰老研究（MHAS， n= 13，798）。这些队列包括协调的纵向认知测量，这些测量与以下因素密切相关： 痴呆风险仅用美国的数据几乎不可能解释选择性移民。组合的数据的 从墨西哥和美国的队列中，我们包括移民和非移民，使我们能够测试 在墨西哥，痴呆症风险和导致痴呆症风险的主要因素是否存在差异 美国人在考虑移民模式后。这项两国研究将使我们能够（目标1）量化 从墨西哥到美国的选择性移民和返回墨西哥的移民， 儿童和成人痴呆症的风险因素可能影响移民模式。然后我们将创建一个 “迁移倾向”评分。该评分将采用新的方法来评估社会贡献 选择性移民偏见的因素，基于评估墨西哥裔美国人的相对社会地位 出生在墨西哥，美国出生的墨西哥裔美国人和美国出生的非拉丁裔白人，而不是直接 比较具有相同绝对社会地位的人。用这个分数来解释选择偏差， 我们将展示墨西哥裔美国人与美国人在痴呆风险方面的差异幅度（目标2） 非拉丁裔白人和（目标3）与移民到美国相关的痴呆症风险差异进行比较 留在墨西哥的人。墨西哥社会经济因素与健康之间的联系 美国人是不确定的，所以我们将（目标4）确定教育，家庭和邻里的影响 不利条件，以及对墨西哥裔美国人痴呆症风险的歧视， 迁移这项研究将提供关于美国人口增长中痴呆症风险的关键信息 以及其他弱势群体或移民群体。