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

项目摘要/摘要 阿尔茨海默病和相关痴呆症(ADRD)是一种不断升级的国家危机，它决定了总体水平 人口健康，包括平均预期寿命。至关重要的是，为了有效地解决这场危机， 我们必须确定其根本原因，其中可能包括健康的社会决定因素，如 教育支出和社会流动性，我们通过相应的政策改变了这些根本原因。 虽然少数SDoH已被证明可以预测认知能力下降和ADRD，但重要的问题仍然存在 关于哪些SDoH是根本的社会驱动因素，即影响最大。尽管越来越多的人呼吁 我们缺乏揭示和解决ADRD根本原因--社会决定因素--的比较评估 了解与修改SDoH相关的相对ADRD负担和经济影响，包括 社会保障福利税等政策。此外，我们还没有确定哪些亚群 受SDoH影响最大。有了这些信息，就需要准确地估计SDoH影响， 包括按人口分组；并将这些估计数转化为确定优先事项的工具，包括对可持续发展的影响 负担和成本。如果不加以解决，这些关键需求将阻碍制定更多 有效减轻ADRD负担和不公平。我们的总体目标是使用大型多层次、纵向 构建第一个比较评估证据的数据集和准实验方法 基于ADRD负担和不平等的社会驱动因素。我们将通过努力实现总目标 使用50岁以上成年人的数据进行以下具体目标：具有全国代表性的死亡率差异 在美国社区研究中，链接到国家死亡率数据库；具有全国代表性的健康和 退休研究，与联邦医疗保险索赔数据相关联；以及NIH的我们所有人计划，一项与以下内容相关的多种族研究 关于健康状况诊断/治疗的电子健康记录(EHR)数据：目的1)评估 地区层面SDOH的影响，包括国家政策作为防止ADRD死亡的保护因素， 可能因健康差距人群而异；目标2)评估地区一级SDoH对 中年人记忆力减退与老年人认知障碍和痴呆的发生率 成人；目的3)探索区域层面SDoH预防ADRD的机制 发病率和认知损害/下降，包括身体/精神健康障碍和生物标记物； 以及目标4)确定哪个区域级别的SDoH如果修改，预计将产生最大的减少 在ADRD负担和成本方面的水平和不平等。关于影响，我们将确定最有希望的 对SDoH进行干预，以改善ADRD的负担和不平等。我们将进一步建立 按亚群区分漏洞的途径。通过将估计转化为人口健康指标， 我们预计我们的项目将通过指导政策制定者的循证思维产生很高的翻译影响 关于政策的决定，以更有效地减轻ADRD在美国人中的负担和不平等。

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.