Racial Disparities in Alzheimer's Disease and Related Dementias: The Role of School Segregation and Experiences of Discrimination

阿尔茨海默病和相关痴呆症的种族差异：学校隔离的作用和歧视经历

• 批准号: 10606362
• 负责人: Sirena Celeste Gutierrez
• 金额: $ 4.72万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-01 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10606362
• 关键词: Address; Adult; Affect; African American population; Age; Aging; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Black Populations; Black race; Chronic; Cognitive; Cognitive aging; Competence; Dementia; Desegregation; Discrimination; Disparity; Education; Elderly; Employment Opportunities; Environment; Epidemiologic Methods; Epidemiologist; Ethnic Population; Event; Exposure to; Funding; Future; Goals; Health; Hypertension; Impaired cognition; Income; Individual; Inequity; Intervention; Life; Life Cycle Stages; Life Experience; Link; Longitudinal cohort; Measures; Mediator; Mentorship; Methodology; Methods; Neighborhoods; Not Hispanic or Latino; Occupational; Outcome; Participant; Pathway interactions; Patient Self-Report; Physiological; Policies; Population; Population Heterogeneity; Population Intervention; Public Health; Race; Racial Segregation; Records; Research; Research Personnel; Research Support; Risk; Risk Factors; Role; Schools; Scientist; Shapes; Social Environment; Socioeconomic Status; Structural Racism; System; Time; Training; United States; Work; aged; aging brain; biological adaptation to stress; brain health; cardiovascular risk factor; career; cognitive function; cohort; dementia risk; early childhood; educational atmosphere; experience; first grade; health care availability; health inequalities; healthy aging; high risk; improved; insight; middle age; mild cognitive impairment; ninth grade; perceived discrimination; poor health outcome; prevent; racial difference; racial disparity; racial population; racism; residential segregation; school environment; segregation; sixth grade; skills; social factors; socioeconomics; stressor; twelfth grade

PROJECT SUMMARY Alzheimer’s disease and related dementias (ADRDs) are a major public health burden and disproportionately affect Black individuals. Although socioeconomic and cardiovascular risk factors partially account for this, experiences of structural (e.g. school segregation) and interpersonal racism (e.g. discrimination) could be important drivers of cognitive inequities. The racialized experience of school segregation can have pervasive effects on sustained discriminatory events and poor health outcomes because of stress-response activation, in addition to decreased socioeconomic opportunities, which may contribute to increased ADRDs risk. Limited studies on the impact of school segregation on late-life cognitive outcomes have produced mixed findings and did not consider incident dementia risk. Additionally, prior studies have not considered mid or late-life mediators of the association between school segregation or quantified the timing of school segregation. Thus, the rationale for the proposed research is to delineate the association of school segregation and resulting experiences of interpersonal discrimination on ADRDs risk to explain why Black individuals have a higher ADRDs burden than other racial and ethnic groups and to identify potential strategies to prevent ADRDs and reduce ADRDs disparities (e.g. organization and occupational policies to reduce racism). The analysis will leverage the Study of Healthy Aging in African Americans and Kaiser Healthy Aging and Diverse Life Experiences, NIA-funded longitudinal cohorts of older adult populations in the United States. The overall objective of this application is to examine the effect of school segregation on ADRDs inequities among older Black and White adults (ages 50-89). This project will also address how experiences of discrimination across the lifecourse impact cognitive trajectories and ADRDs risk. Specifically, this study will evaluate the association between attendance at a racially segregated school on cognitive decline and ADRDs risk among Black individuals (Aim 1) and evaluate the role of everyday and major life discrimination as mediators of this association (Aim 2). Finally, the proposed study will estimate the extent to which racial differences in cognitive decline and ADRDs risk are contributed by differential exposure to school segregation, everyday discrimination, and major life discrimination among Black and White individuals (Aim 3). Examining the roles of sociocontextual factors on ADRDs risk in a large, diverse cohort of Black and White individuals will provide valuable insight into the sustained effects of structural and interpersonal racism on ADRDs risk and will inform population interventions to reduce ADRDs inequities including the targeting of intermediate or proximal mechanisms (e.g. improving neighborhood and educational quality, enhancing access to additional income and employment opportunities). The proposed training, guided by an exemplary mentorship team, will enhance the applicant’s methodological skills, research competency, and content expertise needed for her career as a future independent researcher in ADRDs focused on strategies to reduce racial inequities.

项目摘要 阿尔茨海默氏病和相关痴呆症（ADRD）是主要的公共卫生烧伤，不成比例地 影响黑人个体。尽管社会经济和心血管危险因素部分解释了这一点，但 结构性（例如学校种族隔离）和人际种族主义（例如歧视）的经历可能是 认知不平等的重要驱动力。学校种族隔离的种族化经验可能会普遍存在 由于压力反应激活而对持续的歧视性事件和健康状况不佳的影响 除了减少社会经济机会，这可能导致ADRDS风险增加。有限的 关于学校隔离对晚年认知结果的影响的研究产生了不同的发现和 没有考虑事件痴呆症风险。此外，先前的研究尚未考虑中期或晚期 学校种族隔离或量化学校隔离时间之间的关联的调解人。那， 拟议的研究的理由是描述学校种族隔离的关联和由此导致的 人际歧视对ADRDS风险的经历，以解释为什么黑人有更高的 与其他种族和种族相比，ADRD燃烧，并确定预防ADRD和的潜在策略 减少ADRDS差异（例如，组织和占领政策以减少种族主义）。分析将 利用非裔美国人和凯撒健康衰老的健康衰老的研究 经验，NIA资助了美国的老年人群的纵向人群。总体 该应用的目的是检查学校种族隔离对年龄较大的ADRD不平等的影响 黑白成年人（50-89岁）。该项目还将解决歧视的经历 生命力影响认知轨迹和ADRDS风险。具体而言，本研究将评估关联 在大致隔离的学校因认知能力下降的隔离学校和黑人风险之间 个人（AIM 1）并评估每天的作用和重大生活歧视作为调解人 协会（目标2）。最后，拟议的研究将估计认知的种族差异的程度 衰落和ADRDS风险是由于每天的差异而导致的学校隔离差异 黑人和白人之间的歧视和重大生活歧视（目标3）。研究角色 在大型黑人和白人人群中，ADRDS风险的社会上下文因素将提供 对结构和人际种族主义对ADRDS风险的持续影响的有价值的见解，并将告知 减少ADRDS不平等的人口干预措施，包括靶向中间或近端 机制（例如，提高社区和教育质量，增强获得额外收入的机会， 就业机会）。在示例心态团队指导下的拟议培训将增强 申请人的方法论技巧，研究能力和内容专业知识是她的职业生涯 ADRD的未来独立研究人员的重点是减少种族不平等的策略。