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(ADRD) 少数族裔将背负不成比例的负担。虽然众所周知，某些种族/民族群体，如 非洲裔美国人患痴呆症的几率更高，造成差异的原因尚不清楚。通过教育和 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。我们建议考察教育质量和职业的作用 血管性脑损伤和神经退行性变的认知功能减退、ADRD和影像指标的复杂性 具有无与伦比的种族/民族多样性的一群人。这项拟议的研究得出了教育质量的衡量标准 和职业复杂性，以Kaiser Permanente Northern的以下丰富数据源为基础 加利福尼亚州：多阶段健康检查期间完成的详细社会和身体测量 20世纪60年代至90年代；1996年后的电子病历；以及详细的社会、认知和 Kaiser健康老龄化和多样化生活体验(KANDLE)研究中的神经成像测量 评估。Khandle收集一年级、六年级、九年级和十二年级的学校名称和地点 以及上过的学院或大学，这将与学校质量的历史指标联系起来。 收集到的有关职业的全面信息有助于描绘 成年期早、中、晚。利用这些全面的数据源，我们处于独特的地位 顺利完成本研究的目标是：1)评估教育质量在教育中的作用 认知功能减退、ADRD发生率及脑血管损伤和神经变性的影像标记物 非裔美国人、白人、亚洲人和拉丁裔人；2)考察职业复杂性在 认知功能减退、ADRD发生率以及血管脑损伤和神经变性的影像标记物 不同的队列；3)描绘了整个生命过程中教育质量和职业复杂性的模式 调节ADRD、认知功能减退和血管脑损伤的影像标记物的种族和民族差异 和神经退化。根据美国国立卫生研究院科学状况的建议，利用生命周期方法 预防认知能力下降，拟议的研究将增加有关特征和 与ADRD有关的教育质量和职业复杂性特征的时间安排，并可告知 未来的干预措施，旨在改善所有种族/民族老年人的认知。考虑到被标记的 不同种族/民族的ADRD比率差异从来没有像现在这样关键，我们需要了解 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.