Mechanisms of Cognitive Decline Across Socioeconomic and Clinical Contexts

项目总结/摘要 与美国人的社会经济地位（SEP）有关的健康结果的不平等正在上升，尽管最近 有证据表明，美国黑人和白色人之间的预期寿命差距可能正在缩小。视差 职业生涯最高和最低十分位的个人之间的预期寿命（假设活到50岁） 在过去的20年里，收入几乎翻了一番。2新兴的研究表明，这些不平等 在认知能力下降的研究中也观察到，种族和少数民族以及低 在多项研究中，社会经济状况显示出更早发作或更快的认知能力下降。一个 对健康和退休研究的分析进一步发现，社区的社会经济地位 (SEP)和心血管危险因素增加了老年人认知功能低下的几率。 我们目前的研究，“建模和预测动脉粥样硬化风险：一个复杂的系统方法” （R 01 AG 055480）正在利用电子健康记录（EHR）数据， 登记，以了解邻里社会环境如何影响整个生命过程中的心血管风险。 NEOCARE学习健康登记处包括1999年至2019年收集的310多万人的数据 独特的个体，不同的种族和民族在东北俄亥俄州。在本附录中，我们将实施 多方面的，基于系统的方法，用于联合建模认知和心血管疾病的风险。我们 这项工作将评估邻里条件对老年痴呆症发病率和患病率的影响， 相关的痴呆症我们还将描述高血压和认知功能之间的关系， 社会经济谱，特别关注抗高血压治疗的中介影响。 最后，我们的目的是调查和比较免疫血液学功能，肥胖， 心血管疾病和SEP对认知功能的影响。我们的研究结果有望改善 （一）促进更深入地了解初级保健服务的有效性和提供情况， 和长期的背景因素，包括患者的社会和物理环境，导致变化， 阿尔茨海默病的发病和结果;（ii）确定和量化可改变风险的重要性 可用于制定特定人群干预措施的异质人群因素， 预防或延缓阿尔茨海默氏症和痴呆症的发作。这项研究有望产生新的机制 洞察力，在未来的研究应用中进行测试的假设，更准确和有代表性的模型， 预测阿尔茨海默病和痴呆症，并为多个战略和决策提供依据。 方案层面。

PROJECT SUMMARY/ABSTRACT Inequality in health outcomes in relation to Americans’ socioeconomic position (SEP) is rising, despite recent evidence that the life expectancy gap between black and white Americans may be decreasing1. The disparity in life expectancy (given survival to age 50) between individuals in the top and bottom deciles of career earnings has nearly doubled over the last 20 years.2 Emerging research has indicated that these inequalities are also observed in studies of cognitive decline, with racial and ethnic minorities and persons of low socioeconomic status demonstrating earlier onset or more rapid cognitive decline in multiple studies. An analysis of the Health and Retirement Study has further found that neighborhood socioeconomic position (SEP) and cardiovascular risk factors increase the odds of poor cognitive function among older adults. Our current NIA-funded study, “Modeling and Forecasting Atherosclerotic Risk: A Complex Systems Approach” (R01AG055480) is utilizing electronic health record (EHR) data in a first-of-its-kind regional, population-derived registry to understand how neighborhood social contexts influence cardiovascular risk across the life course. The NEOCARE Learning Health Registry includes data collected from 1999 to 2019 on more than 3.1 million unique individuals, diverse by race and ethnicity in Northeast Ohio. In this supplement we will implement a multifaceted, systems-based approach for jointly modeling risk of cognitive and cardiovascular disorders. Our work will evaluate the influence of neighborhood conditions on incidence and prevalence of Alzheimer’s and related dementias. We will also describe the relationship between hypertension and cognitive function across the socioeconomic spectrum, with a special focus on the mediating influence of antihypertensive therapies. Lastly, we aim to investigate and compare the influence of immuno-hematologic function, obesity and cardiovascular disease and SEP on cognitive function. The results of our study are expected to improve the effectiveness and delivery of primary care services by (i) promoting a deeper understanding about how short and long-term contextual factors involving patients’ social and physical environments lead to variation in Alzheimer’s disease onset and outcomes; and (ii) identifying and quantifying the importance of modifiable risk factors across heterogeneous populations that can be used to develop population-specific interventions to prevent or delay the onset of Alzheimer’s and dementia. This research is anticipated to yield new mechanistic insights, hypotheses for testing in future research applications, more accurate and representative models for predicting Alzheimer’s disease and dementia, and a basis for informing decisions at multiple strategic and programmatic levels.