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Identifying and Addressing Social Determinants of Health to Reduce the National Burden of and Inequities in Dementia

识别和解决健康的社会决定因素，以减轻痴呆症的国家负担和不平等现象

基本信息

批准号：
10597433
负责人：
Daniel Kim
金额：
$ 238.05万
依托单位：
NORTHEASTERN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-01-01 至 2025-12-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10597433
关键词：
Address Adjusted Life Years Adult Affect Age All of Us Research Program Alzheimer&apos s disease related dementia Alzheimer&apos s disease risk American Area Biological Markers Cause of Death Cessation of life Cognitive Communities Cost Savings DNA Methylation Data Databases Dementia Diagnosis Disparity Economics Education Elderly Electronic Health Record Epidemiology Ethnic Origin Future Gender Goals Health Health and Retirement Study Hospitals Hypertension Impaired cognition Incidence Inequity Knowledge Left Length Life Expectancy Link Longitudinal Studies Machine Learning Measures Mediation Medicare claim Memory Memory Loss Mental Depression Mental disorders Modeling Outpatients Participant Pathway interactions Policies Policy Maker Population Prevention Research Productivity Public Policy Quality-Adjusted Life Years Quasi-experiment Race Risk Risk Factors Shapes Social Mobility Social Security Socioeconomic Status Taxes Testing Translating United States United States National Institutes of Health Vulnerable Populations Wages Woman comparative cost development policy economic impact ethnic minority population evidence base health data health disparity populations improved innovation longitudinal dataset middle age models and simulation mortality mortality disparity multi-ethnic novel physical conditioning population health predictive modeling protective factors public health relevance racial minority population response risk mitigation social social determinants social health determinants telomere tool translational impact

项目摘要

PROJECT SUMMARY/ABSTRACT Alzheimer’s disease and related dementias (ADRD) are an escalating national crisis that shapes overall levels of population health including average life expectancy. Critically, in order to effectively address this crisis, it is imperative that we identify its root causes, which may include social determinants of health (SDoH) such as education spending and social mobility, and that we modify these root causes through corresponding policies. While a handful of SDoH have been shown to predict cognitive decline and ADRD, important questions remain about which SDoH are root social drivers i.e., have the greatest impacts. Despite increasing calls for comparative assessments to unpack and address the root causes—the social determinants—of ADRD, we lack knowledge on the relative ADRD burden and economic impacts associated with modifying SDoH, including policies such as the social security benefits tax. Furthermore, we have yet to establish which subpopulations are most affected by SDoH. Given this information, there are critical needs to accurately estimate SDoH impacts, including by subpopulation; and to translate these estimates into priority-setting tools including impacts on ADRD burden and costs. Left unaddressed, these critical needs will hinder the development of policies to more effectively reduce ADRD burden and inequities. Our overall objective is to use large multilevel, longitudinal datasets and quasi-experimental approaches to construct the first comparative assessment evidence base on the social drivers of ADRD burden and inequities. We will accomplish our overall objective by pursuing the following specific aims using data in adults age 50+ from: the nationally-representative Mortality Disparities in American Communities Study, linked to national mortality databases; the nationally-representative Health and Retirement Study, linked to Medicare claims data; and the NIH’s All of Us Program, a multiethnic study linked to electronic health records (EHR) data on diagnoses/treatments of health conditions: Aim 1) To assess the impacts of area-level SDoH including state policies as protective factors against ADRD mortality, that may vary across health disparity populations; Aim 2) To evaluate the impacts of area-level SDoH on memory decline in middle-aged adults and incidence of cognitive impairment and dementia in older adults; Aim 3) To explore the mechanisms through which area-level SDoH may protect against ADRD incidence and cognitive impairment/decline, including physical/mental health disorders and biomarkers; and Aim 4) To ascertain which area-level SDoH, if modified, are expected to yield the greatest reductions in levels of and inequities in ADRD burden and costs. Regarding impact, we will identify the most promising SDoH on which to intervene to yield improvements in ADRD burden and inequities. We will further establish the pathways to differential vulnerabilities by subpopulation. By translating estimates into population health metrics, we anticipate our project will have high translational impact through guiding policymakers' evidence-based decisions about policies to more effectively reduce the burden of and inequities in ADRD among Americans.

项目总结/文摘