Impact of Structural Racism on Racial Disparities in Cognitive Impairment

它 认知 估计 据估计，65%的人在70岁时经历某种程度的认知障碍。内 损伤、阿尔茨海默氏病和相关痴呆症是死亡的主要原因， 5.8美国黑人被诊断出患有糖尿病的可能性是白色美国人的两倍。 认知障碍在有认知障碍的老年人中，黑人与白色人相比， 认知功能更差，功能障碍更严重，神经精神症状更严重， 表明种族差异是可以预防的理解 防止 检查健康差异，使用索赔数据评估医疗保健利用率，以及政策分析， 这些差异的来源将提供很好的洞察力， 延缓认知障碍。拟议的K 01的目标是培训候选人， 依靠 她之前的工作主要集中在老年人的人际动力学和社交网络作为风险因素 功能衰退。 实践， 机会 候选 拟议的研究重点是结构性种族主义-更大的政策体系， 和制度，通过创造获得资源的差异来加强种族不平等， - 作为认知障碍种族差异的根本原因。通过这个K 01，他 将（1）将来自美国人口普查、医疗保险索赔和健康与退休研究的数据联系起来， 研究结构性种族主义如何导致认知障碍和痴呆症方面的健康差距;（2）制定一项 了解如何利用基于人口的研究为卫生和非卫生政策提供信息 老年人部门; 公平， 是 广泛 域 设计 在 跨 种族主义 利用 并且，在本发明中， 的 解决方案 培训 个人层面 以及（3）完成痴呆症，社会正义和健康的神经生物学课程 卫生服务研究方法和政策建模方法。耶鲁大学公共卫生学院 一个非凡的环境来进行这种训练。候选人的主要导师丹雅·基恩博士 在住房政策和做法领域的结构性种族主义如何与其他种族主义相互交织方面， 结构性种族主义造成健康不平等。石楠Allore博士（共同导师）是一位专家， 对老年人的观察性研究和临床试验进行统计分析， 痴呆症的种族差异贝琳达·尼达姆博士（共同导师）是健康差距方面的专家 生命历程拟议的项目将研究结构的三个方面之间的联系， 和认知障碍的风险，包括痴呆症，以及这些结果的种族差异;医疗保健 在有认知障碍的个人中;并评估在个人层面上， 医疗补助的扩张，在结构层面上，修改结构性种族主义的不利影响。符合 NIA的研究重点，这项工作的结果将为未来的多层次干预和政策提供信息 减少认知障碍方面的健康差异（RFA：PA-15-349）。此外，以下的组合 研究将成为候选人长期目标的跳板， 风险因素，以评估和解决认知障碍的结构水平的风险因素。 C L F

It cognitive estimated is estimated that 65% of individuals experience some level of cognitive impairment by 70 years of age. Within impairment, Alzheimer's disease and related dementias are a leading cause of death, affecting an 5.8 million Americans.Black Americans are twice as likely as White Americans to be diagnosed with cognitive impairment. And among older adults with cognitive impairment, Black, compared to White, individuals have worse cognitive function, greater functional disability, and more severe neuropsychiatric symptoms, indicating preventable racial disparities. Understanding preventing examining health disparities, using claims data to assess healthcare utilization, and policy analysis, sources of these disparities will provide great insight into and delaying cognitive impairment. The goal of the proposed K01 is to train the candidate in to build on her prior work, which has focused on interpersonal dynamics and social networks of older adults as risk factors for functional decline. practices, opportunities candidate The proposed research focuses on structural racism – the larger system of policies, and institutions that reinforces racial inequality by creating differential access to resources and – as a fundamental cause of racial disparities in cognitive impairment. Through this K01, t he will (1) link data from the US Census, Medicare claims, and the Health and Retirement Study, to examine how structural racism leads to health disparities in cognitive impairment and dementia; (2) develop an understanding of how population-based research can be leveraged to inform policies in health and non-health sectors for older adults; equity, is extensive domains design in across racism utilization and, the solutions training individual-level and (3) complete oursework in neurobiology of dementia, social justice and health methods in health services research, and policy modeling approaches. The Yale School of Public Health a phenomenal environment to pursue this training. The candidate's primary mentor, Dr. Danya Keene, has expertise in how structural racism in the domain of housing policies and practices, intersects with other of structura racism to create health inequalities. Dr. Heather Allore (co-mentor) is an expert in the and statistical analysis o observational studies and clinical trials for older adults, with a special interest racial disparities in the context of dementia. Dr. Belinda Needham (co-mentor) is an expert in health disparities the life course. The proposed project will examine the association between three dimensions of structural and risk of cognitive impairment, including dementia, and racial disparities in these outcomes; health care among individuals with cognitive impairment; and assess whether s ocial support, at the individual level, Medicaid expansion, at the structural-level, modify the adverse effects of structural racism. Consistent with research priorities of NIA, findings f rom this work will inform future multi-level interventions and policy to reduce health disparities in cognitive impairment (RFA: PA-15-349). Further, the combination of and research will serve as a spring board for the candidate's long-term goal to move the field beyond risk factors to evaluate and address structural-level risk factors for cognitive impairment. c l f