Explaining racial and ethnic Alzheimer’s disease disparities with joint estimation of life course social inequities and measurement bias in verbal memory assessment

通过生命历程社会不平等和言语记忆评估中的测量偏差的联合估计来解释种族和民族阿尔茨海默病差异

• 批准号: 10387926
• 负责人: William Goette
• 金额: $ 3.71万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 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/10387926
• 关键词: Adult; Affect; Aging; Alzheimer disease detection; Alzheimer' s Disease; Alzheimer' s disease diagnosis; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Behavioral; Cessation of life; Childhood; Clinical; Cognitive; Cognitive aging; Complex; Data Set; Detection; Development; Diagnosis; Disease; Early Diagnosis; Education; Equation; Ethnic Origin; Ethnic group; Face; Fellowship; Food; Funding; Goals; Grant; Growth; Health; Health Disparities Research; Health Services Accessibility; Health and Retirement Study; Impaired cognition; Impairment; Individual; Institutional Racism; Joints; Learning; Life Cycle Stages; Life Experience; Link; Longevity; Measurement; Measures; Mediating; Memory; Mentors; Methods; Minority Groups; Modeling; National Institute on Aging; Neuropsychological Tests; Neuropsychology; Occupational; Pathway interactions; Persons; Production; Property; Protocols documentation; Psychometrics; Race; Registries; Research; Research Personnel; Risk; Role; Sampling; Social Class; Social Justice; Social Mobility; Socioeconomic Status; Statistical Methods; Stress; Stress Tests; Structural Racism; Sum; Telephone Interviews; Test Result; Testing; Time; Training; Training Support; United States; accurate diagnosis; aging population; base; brain health; caregiving; cognitive interview; cognitive testing; data harmonization; dementia risk; diagnostic accuracy; disease disparity; ethnic difference; ethnic minority; health care availability; health data; health disparity; improved; marginalized population; mental state; novel; perceived discrimination; performance tests; psychosocial; racial and ethnic; racial and ethnic disparities; racial bias; racial difference; racial minority; response; screening; segregation; social; social culture; social determinants; social factors; social stress; statistics; stressor; theories

Project Summary/Abstract Marginalized populations have both greater rates of Alzheimer’s disease (AD) and greater risk of misdiagnosis, which can delay access to treatment and caregiving. These differences reflect a life course cascade of social inequity in the United States that disproportionately impacts historically marginalized racial and ethnic groups and results in a host of physical and cognitive health disparities. Racial and ethnic differences in neuropsychological test performance, which is commonly used to diagnose AD, are well- documented and may contribute to racial/ethnic differences in the detection and diagnosis of AD. The effects of this structural racism begin in early life experiences and extend to educational and occupational opportunities, social mobility, wealth accumulation, and stress. Differences in social classes of origin (SCO) often persist across the lifespan and develop into differences in adult socioeconomic status (SES). Associated with adult SES are additional contextual SES factors that can mediate health risks like food scarcity and access to healthcare. Beyond SES and associated financial stressors, racial and ethnic minorities also face greater social stress from experiences of discrimination, which have been linked to greater cognitive risk. These differences in risk compound measurement biases in neuropsychological testing, making accurate diagnosis of impairment more difficult and contributing to the observed racial/ethnic differences in scores. The proposed study will examine these complex life course factors to better understand why racial and ethnic disparities arise in AD and how clinicians can reduce the risk of misdiagnosis. In order to study each of these factors in the necessary complexity, the Health and Retirement Study and Harmonized Cognitive Assessment Protocol datasets will be used to study the effects of SCO, adult SES, contextual SES factors, stress, and test bias on verbal memory, which robustly declines early in the AD disease course. The first two study aims utilize Bayesian explanatory item response theory to separate group-level racial/ethnic differences attributable to measurement bias in the tests themselves from the effects of life course social inequities as a cause of the group-level differences. The final aim will test the resulting models’ ability to improve diagnostic accuracy for AD among minority populations. In line with the National Institute of Aging’s Health Disparities Research Framework, these models leverage environmental, sociocultural, and behavioral factors to understand the interactions and pathways that life course differences have in normal and abnormal aging, dementia risk, and measurement bias. The fellowship will support training and mentoring in the complexities of normal and abnormal cognitive aging, sophisticated statistical methods, and role of social equity in AD assessment to support my growth as a researcher in AD disparities and the development of new methods to improve detection of AD among the increasingly diverse aging population.

项目总结/摘要 边缘化人群患阿尔茨海默病（AD）的几率更高， 误诊，这可能会延误获得治疗和康复。这些差异反映了一个生命历程 美国社会不平等的级联，不成比例地影响了历史上被边缘化的种族 和种族群体，并导致身体和认知健康的差距主机。种族和族裔 神经心理学测试表现的差异，通常用于诊断AD，是很好的- 记录，并可能导致AD检测和诊断中的种族/民族差异。 这种结构性种族主义的影响开始于早年的生活经历，并延伸到教育和 职业机会、社会流动性、财富积累和压力。社会阶层的差异 起源（SCO）通常持续整个生命周期，并发展成成人社会经济地位的差异 （SES）。与成人社会经济地位相关的是额外的社会经济地位因素，这些因素可以介导健康风险，如食物 稀缺和获得医疗保健。除了社会经济地位和相关的财务压力，种族和少数民族 也面临着更大的社会压力，从歧视的经验，这已与更大的认知 风险这些风险的差异复合了神经心理学测试中的测量偏差， 更难诊断损伤，并导致观察到的种族/民族评分差异。 这项拟议中的研究将研究这些复杂的生命过程因素，以更好地了解为什么种族和 AD中出现的种族差异以及临床医生如何减少误诊的风险。为了研究 这些因素在必要的复杂性，健康和退休研究和协调认知 评估方案数据集将用于研究SCO、成人SES、情境SES因素， 压力，和测试偏见的口头记忆，强烈下降早期AD疾病的过程。前两 研究目的是利用贝叶斯解释性项目反应理论来分离组水平的种族/民族差异 归因于测试本身的测量偏差，来自生命过程社会不平等的影响， 这是群体差异的原因。最终的目标将测试由此产生的模型的能力，以提高诊断 在少数民族人群中AD的准确性。根据国家老龄化研究所的健康差异， 研究框架，这些模型利用环境，社会文化和行为因素， 了解生命过程差异在正常和异常衰老中的相互作用和途径， 痴呆风险和测量偏差。该奖学金将支持复杂领域的培训和指导 正常和异常的认知老化，复杂的统计方法，以及社会公平在AD中的作用 评估，以支持我的成长为一个研究人员在广告差距和新方法的发展， 在日益多样化的老龄人口中提高AD的检测率。