The Contributions of Education to Sex/Gender Disparities in Alzheimer's Disease and Alzheimer's Disease-Related Dementias

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PROJECT SUMMARY/ABSTRACT Women are disproportionately affected by Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD) relative to men. Prior research focuses overwhelmingly on sex-related biological explanations for this disparity, but the consequences of gender-related social and behavioral factors may also be considerable. The proposed research will make progress towards understanding these consequences through two Aims. Both Aims leverage data from the Health and Retirement Study, a nationally representative panel survey of older U.S. adults that includes information on respondents’ cognitive state as well as demographic, social and economic, and health-related characteristics. Aim 1 is to characterize the contributions of education to trends in AD/ADRD by sex/gender. Analyses will first document sex/gender-specific trends in AD/ADRD prevalence from 2000 to 2016. Variance decomposition will then be used to quantify how much of the observed changes in prevalence were due to changes in levels of education and to changes in effects of education on AD/ADRD. Aim 2 is to examine how education combines with work and occupation to produce patterns of AD/ADRD by sex/gender. First, patterns of workforce participation and occupational characteristics by sex/gender and education will be described. Path analysis will then be used to evaluate whether and how workforce participation and occupational characteristics mediate relationships between education and AD/ADRD for women and men. The proposed research builds on Dr. Zacher’s prior quantitative training and research on education, sex/gender, and health. It will also require Dr. Zacher to build additional expertise in aging, AD/ADRD, and demographic methods. Towards this end, Dr. Zacher will undertake extensive training during the K01 award period with the guidance of an impressive mentoring team led by Dr. Susan Short, Professor of Sociology and Director of the Population Studies and Training Center at Brown University. Co-mentors include Drs. Eileen Crimmins, AARP Professor of Gerontology, USC Leonard Davis School of Gerontology; David Dosa, Associate Professor of Medicine and Health Services, Policy and Practice, Brown University; Richard Jones, Professor of Neurology and Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University; and Vincent Mor, Florence Pirce Grant University Professor and Professor of Health Services, Policy and Practice, Brown University. Dr. Zacher’s training will support her short-term goal of completing the proposed K01 research successfully while also preparing her for her long-term career goal of becoming an independent investigator and expert on the demography of aging and AD/ADRD, with a special focus on sex/gender and education.