Contributions of educational quality and occupational complexity on racial and ethnic inequities in brain health and Alzheimer's disease and related dementia

摘要 到2050年，美国将有近1400万人患有阿尔茨海默病和相关痴呆症（ADRD）。 少数族裔将承受沉重的负担。虽然众所周知，某些种族/族裔群体，如 非裔美国人痴呆症的发病率较高，差异的原因尚不清楚。虽然教育和 职业与ADRD密切相关，关于教育质量和职业复杂性的研究 主要只包括白人，或者在检查种族/民族差异时，侧重于比较 白人和非裔美国人。我们建议审查教育质量和职业 复杂性对认知下降、ADRD和血管性脑损伤和神经变性的成像标志物的影响 一个种族/民族多样性无与伦比的群体。拟议的研究得出的教育质量的措施 和职业的复杂性，建立在以下丰富的数据来源，在凯撒永久北方 加州：在2009年10月至2010年12月期间完成的多相健康检查的详细社会和身体指标。 1960年代到1990年代; 1996年以后的电子医疗记录;以及详细的社会、认知和 Kaiser健康老龄化和多样化生活体验（KHANDLE）研究的神经影像学指标 评估。KHANDLE收集了1年级、6年级、9年级和12年级的学校名称和位置 以及上过的学院或大学，这将与学校质量的历史指标挂钩。 收集到的关于职业的全面信息有助于界定职业的复杂性， 成年早期、中期和晚期。利用这些全面的数据源，我们处于一个独特的位置， 成功地完成了研究的目的，这是：1）评估教育质量对 认知能力下降、ADRD发生率以及血管性脑损伤和神经退行性变的影像学标志物 非裔美国人、白色人、亚洲人和拉丁美洲人; 2）检查职业复杂性对 认知功能下降、ADRD发生率以及血管性脑损伤和神经退行性变的影像学标志物， 3）描述整个生命过程中教育质量和职业复杂性的模式 在ADRD、认知下降和血管性脑损伤的影像学标志物方面， 和神经退化利用生命过程方法，如NIH State of the Science所建议的， 预防认知衰退，拟议的研究将增加有关特征的重要信息， 与ADRD相关的教育质量和职业复杂性特征的时间安排， 未来的干预措施旨在提高所有种族/族裔群体的老年人的认知能力。鉴于被标记者 种族/民族群体的ADRD率差异从未有过更关键的时刻来了解如何 社会背景风险因素影响不同人群的大脑健康。

ABSTRACT By 2050 nearly 14 million people will suffer from Alzheimer's disease and related dementias (ADRD) in the US and minorities will be disproportionally burdened. While it is known that certain racial/ethnic groups, such as African Americans, have higher rates of dementia, reasons for disparities are unknown. Though education and occupation are robustly associated with ADRD, research on education quality and occupational complexity has primarily included only Whites or, when examining racial/ethnic differences, focused on comparisons between Whites and African Americans. We propose to examine the role of educational quality and occupational complexity on cognitive decline, ADRD, and imaging markers of vascular brain injury and neurodegeneration in a cohort with unparalleled racial/ethnic diversity. The proposed study derives measures of education quality and occupational complexity, building upon the following rich data sources at Kaiser Permanente Northern California: detailed social and physical measures from a Multiphasic Health Checkup completed during the 1960s to 1990s; electronic medical records from 1996 onward; and detailed social, cognitive, and neuroimaging measures from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study assessments. KHANDLE collects the names and locations of schools attended at 1st, 6th, 9th, and 12th grades as well as college or university attended which will be linked to historical indicators of school quality. Comprehensive information collected regarding occupation enables delineation of occupational complexity in early-, mid-, and late-adulthood. Utilizing these comprehensive data sources, we are in a unique position to successfully complete the aims of the study, which are to: 1) Evaluate the roles of education quality on cognitive decline, ADRD incidence, and imaging markers of vascular brain injury and neurodegeneration in African American, White, Asian, and Latino individuals; 2) Examine the role of occupational complexity on cognitive decline, ADRD incidence, and imaging markers of vascular brain injury and neurodegeneration in this diverse cohort; 3) Delineate if patterns of educational quality and occupational complexity across the lifecourse mediate racial and ethnic disparities in ADRD, cognitive decline, and imaging markers of vascular brain injury and neurodegeneration. Utilizing a lifecourse approach, as recommended by the NIH State of the Science on Preventing Cognitive Decline, the proposed research will add vital information regarding the characteristics and timing of education quality and occupational complexity characteristics associated with ADRD and may inform future interventions aiming to improve cognition among elderly of all racial/ethnic groups. Given the marked disparities in ADRD rates by racial/ethnic groups there has never been a more critical time to understand how sociocontextual risk factors impact brain health in diverse populations.