Reducing Disparities in Dementia and VCID Outcomes in a Multicultural Rural Population

减少多元文化农村人口中痴呆症和 VCID 结果的差异

• 批准号: 10121122
• 负责人: James E Galvin
• 金额: $ 127.8万
• 依托单位: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-03-06 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10121122
• 关键词: Reducing; Disparities; Dementia; VCID; Outcomes

ABSTRACT Alzheimer's disease and related dementias (ADRD) affect millions of Americans. Persons living in rural areas face increased prevalence (OR=1.1) and incidence (OR=1.2) of ADRD compared to urban/suburban dwellers with increased disparities affecting health outcomes. Underlying factors that may increase ADRD risk and disparities in health outcomes include: poverty; low education; poor health literacy; poor nutrition; tobacco, alcohol and substance abuse; limited access to care (specialists, diagnostic testing); migrant or marginal immigration status; and non- and underinsurance. In addition to rurality, race and ethnicity may play a role in ADRD. African Americans are 2 times as likely and Hispanics are 1.5 times more likely than Whites to develop ADRD that may be due to different risk profiles, particularly vascular risks. These social, biologic, and genetic determinants increase risk for multiple chronic conditions associated with vascular contributions to cognitive impairment and dementia (VCID). We propose to study health disparities associated with ADRD and more specifically VCID in culturally heterogeneous older adults living in a rural setting compared with older adults living in an urban/suburban setting. Comparison populations reside either in the (a) western rural portion of Palm Beach County, FL (locally referred to as “the Glades”) or (b) the more metropolitan and affluent coastal portion of Palm Beach County (locally referred to as “the Coast”). The overall HYPOTHESIS is that rurality, combined with low SES, cultural characteristics, vascular risk factors, environment and lifestyle factors, and genetic traits synergistically increase the risk for ADRD and in particular VCID. These same factors contribute to disparities in health outcomes for rural populations compared to similar groups of older adults from urban/suburban communities. We propose these SPECIFIC AIMS: (1) Conduct a cross-sectional, population- based study of the Glades with phenotype and genotype of participants to determine the prevalence of ADRD/VCID; (2) Conduct a longitudinal study of individuals randomly selected from Aim 1 and compare to an age- and racial/ethnicity-matched sample of suburban/urban older adults recruited for longitudinal follow-up; (3) Evaluate cross-sectional relationships at baseline, 18mos, and 36mos between clinical, functional, psychosocial, genetic, and biomarker variables and cognitive performance for the cohort as a whole, and stratified by relevant biological variables; and (4) Model baseline and longitudinal clinical, functional, psychosocial, behavioral, genetic, and biomarker variables to predict cognitive impairment and rate of progression from normal cognition to MCI, and MCI to ADRD/VCID for the cohort as a whole, and stratified by relevant biological variables. Our short-term goals are to determine prevalence and profile of transition from normal aging to ADRD/VCID, in a rural population compared to urban/suburban settings; identify and characterize unique genetic and biomarker features; and explore social and biologic determinants of brain health. Our long-term goal is to reduce health disparities.

抽象的 阿尔茨海默病和相关痴呆症 (ADRD) 影响着数百万美国人。生活在农村地区的人们面临着 与城市/郊区居民相比，ADRD 患病率 (OR=1.1) 和发病率 (OR=1.2) 增加 影响健康结果的差距扩大。可能增加 ADRD 风险和差异的潜在因素 健康成果包括： 贫困；教育程度低；健康素养差；营养不良；烟草、酒精和物质 虐待;获得护理的机会有限（专家、诊断测试）；移民或边缘移民身份；和非和 保险不足。除了农村地区之外，种族和族裔也可能在 ADRD 中发挥作用。非裔美国人是 2 倍 西班牙裔患 ADRD 的可能性是白人的 1.5 倍，这可能是由于不同的风险 概况，特别是血管风险。这些社会、生物和遗传决定因素增加了多种慢性病的风险 与血管导致认知障碍和痴呆 (VCID) 相关的疾病。我们建议 研究与 ADRD 相关的健康差异，更具体地说，研究文化异质性老年人中与 VCID 相关的健康差异 与生活在城市/郊区的老年人相比，生活在农村的老年人。比较人群 居住在 (a) 佛罗里达州棕榈滩县西部农村地区（当地称为“空地”）或 (b) 棕榈滩县更加大都市和富裕的沿海地区（当地称为“海岸”）。整体 假设是农村，结合低社会经济地位、文化特征、血管危险因素、环境 生活方式因素和遗传特征会协同增加 ADRD，特别是 VCID 的风险。这些相同的 与类似老年人群体相比，导致农村人口健康结果差异的因素 来自城市/郊区社区。我们提出以下具体目标：(1) 开展跨部门、人口调查 对 Glades 参与者的表型和基因型进行研究，以确定 ADRD/VCID 的患病率； (2) 对从目标 1 中随机选择的个体进行纵向研究，并与年龄和年龄组进行比较 招募进行纵向随访的郊区/城市老年人的种族/民族匹配样本； (3) 评估 基线、18 个月和 36 个月临床、功能、社会心理、遗传、 以及整个队列的生物标志物变量和认知表现，并按相关生物分层 变量； (4) 模型基线和纵向临床、功能、社会心理、行为、遗传和 用于预测认知障碍和从正常认知到 MCI 的进展率的生物标志物变量，以及 整个队列的 MCI 到 ADRD/VCID，并按相关生物变量进行分层。我们的短期 目标是确定农村人口从正常老龄化向 ADRD/VCID 过渡的患病率和概况 与城市/郊区环境相比；识别和表征独特的遗传和生物标志物特征；并探索 大脑健康的社会和生物决定因素。我们的长期目标是缩小健康差距。