Evaluation of college accessibility and income security interventions as preventative measures for dementia risk and solutions to dementia disparities

对大学入学机会和收入保障干预措施作为痴呆症风险预防措施和痴呆症差异解决方案的评估

• 批准号: 10054598
• 负责人: Anusha Murthy Vable
• 金额: $ 62.24万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10054598
• 关键词: Address; Adult; Affect; African American; Age; Alzheimer' s Disease; Birth; Cause of Death; Cerebrovascular Disorders; Childhood; Chronic; Clinical; Cognitive; Country; Data Set; Date of birth; Dementia; Diagnosis; Dimensions; Disease; Education; Educational Intervention; Educational Status; Elderly; Evaluation; Future; Geography; Goals; Health; Health and Retirement Study; Health behavior; Incidence; Income; Income Tax; Individual; Institution; Intervention; Link; Literature; Long-Term Effects; National Longitudinal Survey of Youth; Neurodegenerative Disorders; Participant; Pattern; Pensions; Policies; Population; Preventive measure; Process; Publishing; Randomized; Reasons for Geographic And Racial Differences in Stroke; Research; Retirement; Risk; Schools; Security; Social Policies; Social Security; Socioeconomic Status; Structure; Subgroup; Testing; United States; United States National Institutes of Health; Variant; Veterans; Vietnam; Vulnerable Populations; War; Work; cohort; college; dementia risk; disorder risk; early life exposure; health data; health disparity; higher education; improved; poverty alleviation; racial and ethnic; rural area; social health determinants; social interventions; social vulnerability; sociodemographics; socioeconomic disparity; socioeconomics; trend

ABSTRACT. Alzheimer's Disease and Related Disorders (ADRD) are leading causes of death in the United States that disproportionately impact individuals with less education and income. There is substantial evidence that ADRD is strongly patterned by socioeconomic status across the lifecourse. However, little prior work has evaluated whether socioeconomic interventions to increase socioeconomic status reduce the population burden of ADRD, or if there are differentially effects by sociodemographic subgroup, resulting in smaller disparities; this proposal addresses this critical gap in the literature. We evaluate socioeconomic interventions that increased years of education (Aim 1) and income security (Aim 2) to determine if such interventions impacted dementia risk overall, and whether structurally minoritized groups (Black Americans, individuals from low childhood SES backgrounds, and people who grew up in rural areas or the South) differentially benefited (Aim 3). We will use data from Health and Retirement Study (HRS), the Reasons for Geographic and Racial Differences in Stroke cohort (REGARDS), and the National Longitudinal Survey of Youth, 1979 cohort to evaluate these aims. Our research team has previously published using all three data sets. Aim 1 will evaluate whether expansion of college access reduced ADRD risk; hypothesis 1 evaluates college geographic accessibility via increases in 2 and 4-year higher education institutions per capita, while hypothesis 2 evaluates college financial accessibility via a large social intervention that subsidized college education (the Vietnam War GI Bill). Aim 2 will evaluate whether policies that increased income security reduced ADRD risk; hypothesis 1 evaluates the long-term effects of a working age poverty-alleviation policy (the earned income tax credit), while hypothesis 2 evaluates retirement income security (Social Security). Aim 3 will evaluate whether the education and income security interventions examined in Aims 1 and 2 reduced socioeconomic, racial, and geographic disparities in ADRD; differential effects will be evaluated using interaction terms, quantile regression, and distributional decomposition. If our hypotheses are confirmed, results from this research will provide direct evidence for solutions to reduce the future population burden of ADRD and disparities in ADRD. Our work can also inform targeting of interventions to those who benefit most. This research will provide immediately actionable evidence, because the interventions we evaluate are specific and feasible.

抽象的。阿尔茨海默病及相关疾病 (ADRD) 是美国的主要原因 对教育程度和收入较低的个人产生不成比例影响的州。有大量证据 ADRD 在整个生命过程中受到社会经济地位的强烈影响。然而，之前的工作很少 评估了提高社会经济地位的社会经济干预措施是否减轻了人口负担 ADRD 的影响，或者社会人口亚组的影响存在差异，导致差异较小；这 提案解决了文献中的这一关键空白。我们评估了社会经济干预措施，增加了 教育年限（目标 1）和收入保障（目标 2），以确定此类干预措施是否影响痴呆症 总体风险，以及结构上是否属于少数群体（美国黑人、儿童社会经济地位低下的个体） 背景以及在农村地区或南方长大的人）受益不同（目标 3）。我们将使用 来自健康与退休研究 (HRS) 的数据，中风的地理和种族差异的原因 队列（REGARDS）和全国青年纵向调查，1979 年队列来评估这些目标。我们的 研究团队此前曾使用所有三个数据集发表过文章。目标 1 将评估是否扩展 进入大学降低 ADRD 风险；假设 1 通过 2 的增加来评估大学地理可达性 和人均四年制高等教育机构，而假设 2 评估大学的经济可及性 通过大规模的社会干预来补贴大学教育（越南战争退伍军人法案）。目标 2 将评估 增加收入保障的政策是否降低了 ADRD 风险；假设 1 评估长期影响 工作年龄扶贫政策（收入所得税抵免），而假设 2 评估 退休收入保障（社会保障）。目标 3 将评估教育和收入保障是否 目标 1 和 2 中审查的干预措施减少了 ADRD 中的社会经济、种族和地理差异； 将使用交互项、分位数回归和分布来评估差异效应 分解。如果我们的假设得到证实，这项研究的结果将提供直接证据 减少 ADRD 未来人口负担和 ADRD 差异的解决方案。我们的工作还可以告知 将干预措施瞄准那些受益最大的人。这项研究将提供立即可行的证据， 因为我们评估的干预措施是具体且可行的。