Structural Racism, Resilience, and Premature Cognitive Aging in End-stage Renal Disease

终末期肾病中的结构性种族主义、复原力和过早认知衰老

• 批准号: 10659198
• 负责人: Mara A. McAdams DeMarco
• 金额: $ 82.72万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-15 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10659198
• 关键词: Accounting; Address; Adult; Age; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Award; Behavioral; Biological; Black race; Chronic Disease; Cognition; Cognitive aging; Cohort Studies; Collaborations; Communities; Compensation; Data; Data Set; Databases; Dependence; Diagnosis; Dialysis procedure; Discrimination; Disparity; Elderly; End stage renal failure; Enrollment; Faith; Family; Foundations; Funding; Glean; Goals; Health Disparities Research; Impaired cognition; Individual; Institution; Institutional Racism; Intervention; Kidney; Life Cycle Stages; Link; Longevity; Measurement; Measures; Mediation; Medicare; Mental Health; Methods; Modeling; National Institute on Aging; Outcome; Participant; Patient Self-Report; Patients; Phase; Policies; Population; Prospective, cohort study; Race; Registries; Risk; Source; Structural Racism; Survival Analysis; Testing; aged; black patient; cognitive function; community engagement; comorbidity; demographics; design; experience; health disparity; health equity; instrument; lifetime risk; perceived stress; premature; prevent; promote resilience; racial difference; racism; resilience

ABSTRACT Only 13% of the 780,000 adults living with end-stage renal disease (ESRD) have normal cognitive function. We found that 14.0% of ESRD patients aged 35-49 experience severe cognitive impairment and 2.9% have a co- occurring functional dependence suggestive of Alzheimer’s disease and related dementia (AD/ADRD). After dialysis initiation older (≥65) patients experience a 21-25% lifetime risk of AD/ADRD. Younger ESRD patients experience premature cognitive aging requiring the study of cognition and AD/ADRD across the lifespan. Black ESRD patients are more than twice as likely to develop cognitive impairment and 70%-78% more likely to be diagnosed with AD/ADRD; this disparity is comparable to a 10 year increase in age. While systemic racism is a known contributor to health disparities in community-dwelling older adults, its impact on cognitive aging among ESRD patients is understudied. Measurement of systemic racism (i.e., structural, institutional, and interpersonal) is crucial to identifying ESRD patients who are at risk of premature cognitive aging and those who are resilient in the face of racism. Elucidating mechanisms by which systemic racism impacts cognitive aging will lead to interventions and policies that may prevent the devastation of AD/ADRD for 234,000 Black ESRD patients. We seek to address a National Institute on Aging (NIA) goal (RFA-MD-21-004): “To elucidate whether and how mechanisms connecting structural racism to aging-relevant outcomes, including cognition and AD/ADRD, operate on multiple levels.” ESRD patients are the ideal population to elucidate these mechanisms: 1) 30% of patients are Black; 2) 87% experience premature cognitive aging; 3) all enroll in a national registry and 65% in Medicare for measurement of institutional racism. For all adult ESRD patients in the national registry/Medicare database, we will glean 23 indicators of structural racism from publicly available data and identify 3 indicators of institutional racism. Then, we will link these data to our ongoing, NIA-funded, multi-center, prospective cohort study (FAIR, n=5,275) of aging and ESRD to fully characterize systemic racism (lifecourse structural racism, institutional racism, and interpersonal racism). This is the oldest (>12 years) ESRD cohort study that includes longitudinal measures global and domain specific cognitive function. The National Kidney Foundation, Alzheimer’s Association, and a local community advisory board will guide the design and interpretation of the following aims: 1) To estimate the impact of structural and institutional racism on incident AD/ADRD; 2) To quantify the contributions of lifecourse systemic racism on cognitive impairment and decline; and 3) To test whether resilience to systemic racism protects against cognitive impairment and decline. By taking a lifecourse approach and engaging community, family, and patient stakeholders in all phases of our study, we will identify feasible targets for improving resilience in the face of systemic racism. These potential targets for interventions and policies to counter structural racism will likely generalize to other populations with chronic diseases.

抽象的 在780,000名患有末期肾脏疾病（ESRD）的成年人中，只有13％具有正常的认知功能。我们 发现35-49岁的ESRD患者中有14.0％的患者经历了严重的认知障碍，而2.9％的患者有共同认知障碍 发生功能依赖性暗示了阿尔茨海默氏病和相关痴呆症（AD/ADRD）。后 透析倡议年龄较大（≥65）患者的AD/ADRD终身风险为21-25％。年轻的ESRD患者 经验过早认知衰老，需要在整个生命周期内研究认知和AD/ADRD。黑色的 ESRD患者出现认知障碍的可能性是两倍以上 被诊断为AD/ADRD；这种差异可与年龄增长10年相媲美。虽然系统性种族主义是 已知的造成社区居民老年人健康差异的贡献者，其对认知衰老的影响 了解ESRD患者。衡量系统性种族主义（即结构，机构和 人际关系）对于识别面临过早认知衰老风险的ESRD患者至关重要 面对种族主义的韧性。阐明系统种族主义影响认知的机制 衰老将导致干预措施和政策，以防止AD/ADRD破坏234,000黑色 ESRD患者。我们寻求谈论国家老化研究所（NIA）目标（RFA-MD-21-004）：“阐明 是否以及如何以及如何将结构性种族主义与与衰老相关的结果连接起来，包括认知 ESRD患者是阐明这些的理想人群 机制：1）30％的患者是黑色的； 2）87％的经验过早认知衰老； 3）全部注册 国家注册表和65％的Medicare用于衡量机构种族主义。对于所有成年ESRD患者 国家注册表/医疗保险数据库，我们将收集23个结构性种族主义指标 数据并确定3个机构种族主义的指标。然后，我们将将这些数据链接到我们正在进行的NIA资助， 多中心，前瞻性队列研究（公平，n = 5,275）的衰老和ESRD，以完全表征全身性 种族主义（生命的结构性种族主义，制度种族主义和人际种族主义）。这是最古老的（> 12 年）ESRD队列研究，其中包括纵向测量全球和领域特定的认知功能。 国家肾脏基金会，阿尔茨海默氏症协会和当地社区顾问委员会将指导 以下目的的设计和解释：1）估计结构和制度种族主义的影响 关于事件广告/ADRD； 2）量化生命性的系统种族主义对认知障碍的贡献 和下降； 3）测试对系统性种族主义的韧性是否可以防止认知障碍和 衰退。通过采用生命力的方法并吸引社区，家庭和耐心利益相关者 我们研究的阶段，我们将确定面对系统性种族主义的可行目标，以提高韧性。 这些对抗结构种族主义的干预措施和政策的潜在目标可能会推广到其他 患有慢性疾病的人群。