Alzheimer’s Disease and Related Dementias in The Most Incarcerated Generation: An Understudied Population with Health Disparities

拟议的项目响应NOT-AG-21-033(健康差距和阿尔茨海默病)，是 司法的第一次纵向和流行病学检查--牵涉和痴呆。谁是美国人 体验正义-参与，从社区到监禁，从监禁回到 社区，正在迅速老龄化。此外，司法介入对有色人种和有色人种的影响不成比例。 社会经济地位低，他们也是各种形式痴呆症的高危人群，但经常被排除在 痴呆症相关研究。这项研究将有助于我们理解痴呆症的健康差异 评估监禁、痴呆症和一些重要的社会风险因素之间的相互关系 以及随时间推移的全国样本中的多种发病因素。我们将优化退役军人健康 管理部门(VHA)从医疗保险和医疗保险中心访问监禁历史文件的能力 医疗补助服务(CMS)。我们建议利用我们为以下目标创建的纵向“监狱释放”队列 另一项由NIH资助的研究和补充(R01 MH117604和S1)。这一群体包括&gt；30,000 同时参加联邦医疗保险和自愿医疗保险的个人，他们在≥50岁时重新进入社区(2008年至2018年) 在一次监禁之后。我们将加强这一群体，以包括2008年间年龄在≥50岁的所有退伍军人 到2022年，包括在这段时间内任何时候被监禁的人和被释放的人，那些 仍然被监禁(没有重新进入社区)，以及从未被监禁的人，总数超过46000人 在1050万退伍军人中，有司法参与的退伍军人。使用这个丰富的纵向数据集，我们拥有 开发与风险相关的社会风险因素概况和多种发病率概况的前所未有的机会 痴呆症患者的监禁风险(目标1)和获释人员患痴呆症的风险 监禁(目标2)。对退伍军人管理局和医疗保险数据的访问提供了更完整的结果确定，因此 增加了确定这些特征是否根据痴呆症亚型而不同的机会(例如， 阿尔茨海默病、血管、额叶、轻度认知障碍(MCI)。我们还将做出新的用途 评估经历不同路径(例如，进入的路径)的概率的过渡模型 从监禁到获释，到发展成痴呆症)，并确定 预测这些途径(目标3)。我们将评估健康差距人群中的所有目标，如非 西班牙裔黑人、西班牙裔、土著/土著群体和那些经历贫困指标的人(例如， 无家可归和社会经济劣势)。这项研究具有重大的公共卫生意义。会的 告知降低痴呆症患者入狱风险的战略，将描述那些风险最高的 监禁后罹患痴呆症的风险，以便为监狱到社区过渡护理规划提供信息， 并将确定优化痴呆症护理可以减少健康差距的主要干预点 在有司法介入和没有司法介入的人之间，甚至在涉及司法的人内部。

The proposed project, which responds to NOT-AG-21-033 (Health Disparities and Alzheimer’s Disease), is the first longitudinal and epidemiological examination of justice-involvement and dementia. Americans who experience justice-involvement, moving from the community to incarceration and from incarceration back to the community, are aging rapidly. Moreover, justice-involvement disproportionately impacts persons of color and of low socioeconomic status, who are also at high risk for all forms of dementia yet are frequently excluded from dementia-related research. This study will contribute to our understanding of health disparities in dementia by evaluating the inter-relationship among incarceration, dementia, and a number of important social risk factors and multi-morbidity factors over time in a national sample. We will optimize the Veterans Health Administration’s (VHA) capacity to access Incarceration History Files from the Centers for Medicare and Medicaid Services (CMS). We propose to leverage a longitudinal “prison release” cohort which we created for a different NIH-funded study and supplement (R01 MH117604 and S1). This cohort includes >30,000 individuals enrolled in both Medicare and VHA, who reentered the community at age ≥50 (between 2008-2018) following an incarceration. We will enhance this cohort to include all veterans who were age ≥50 between 2008 to 2022, including those incarcerated at any point during that timeframe and who were released, those who remained incarcerated (no community reentry), and those never incarcerated, for a total of more than 46,000 justice-involved veterans among 10.5 million veterans. Using this rich, longitudinal dataset, we have the unprecedented opportunity to develop social risk factor profiles and multi-morbidity profiles associated with risk of incarceration among those with dementia (Aim 1) and risk of dementia among those released from incarceration (Aim 2). Access to VA and Medicare data provides more complete outcome ascertainment, thus increasing the opportunity to determine if these profiles differ according to dementia subtypes (e.g., Alzheimer’s Disease, vascular, frontotemporal, mild cognitive impairment (MCI)). We will also make novel use of transition models to evaluate probabilities of experiencing distinct pathways (e.g., pathway to entering incarceration, to being released from incarceration, to developing dementia) and determine precursors that predict these pathways (Aim 3). We will evaluate all Aims within health disparity populations such as non- Hispanic Black, Hispanic, native/indigenous groups and those experiencing indicators of poverty (e.g., homelessness and socioeconomic disadvantage). This study has substantial public health significance. It will inform strategies to mitigate risk of patients with dementia entering incarceration, will delineate those at highest risk of developing dementia after incarceration so as to inform prison-to-community transitional care planning, and will identify prime intervention points where optimizing dementia care could reduce health disparities between those with and without justice-involvement and even within the justice-involved.