Evaluation of college accessibility and income security interventions as preventative measures for dementia risk and solutions to dementia disparities

摘要。阿尔茨海默病及相关疾病（ADRD）是美国的主要死亡原因。 对教育程度和收入较低的个人产生不成比例影响的国家。有大量证据 ADRD与整个生命过程中的社会经济地位密切相关。然而，很少有先前的工作 评估了提高社会经济地位的社会经济干预措施是否会减轻人口负担 ADRD，或者如果社会人口亚组的影响不同，导致差异较小;这 该提案解决了文献中的这一关键空白。我们评估社会经济干预措施， 受教育年限（目标1）和收入保障（目标2），以确定这些干预措施是否影响痴呆症 风险整体，以及是否结构上的少数群体（美国黑人，个人从低童年SES 在农村地区或南方地区长大的人）有差别地受益（目标3）。我们将使用 数据来自健康与退休研究（HRS），中风的地理和种族差异的原因 队列（REGARDS）和全国青年纵向调查，1979年队列，以评估这些目标。我们 研究小组先前使用所有三个数据集发表。目标1将评估是否扩大 大学入学率降低ADRD风险;假设1通过增加2来评估大学地理可达性 和4年制高等教育机构人均，而假设2评估大学财政可及性 通过一个大的社会干预，补贴大学教育（越南战争GI法案）。目标2将评估 增加收入保障的政策是否降低了ADRD风险;假设1评估了长期影响 工作年龄扶贫政策（劳动所得税抵免），而假设2评估 社会保障（Social Security）。目标3将评估教育和收入保障是否 目标1和2中审查的干预措施减少了ADRD的社会经济、种族和地理差异; 差异效应将使用交互作用项、分位数回归和分布 分解如果我们的假设得到证实，这项研究的结果将提供直接证据， 解决办法，以减少未来的人口负担的ADRD和差距的ADRD。我们的工作还可以为 将干预措施的目标对准受益最大的人。这项研究将立即提供可采取行动的证据， 因为我们评估的干预措施是具体可行的。

ABSTRACT. Alzheimer's Disease and Related Disorders (ADRD) are leading causes of death in the United States that disproportionately impact individuals with less education and income. There is substantial evidence that ADRD is strongly patterned by socioeconomic status across the lifecourse. However, little prior work has evaluated whether socioeconomic interventions to increase socioeconomic status reduce the population burden of ADRD, or if there are differentially effects by sociodemographic subgroup, resulting in smaller disparities; this proposal addresses this critical gap in the literature. We evaluate socioeconomic interventions that increased years of education (Aim 1) and income security (Aim 2) to determine if such interventions impacted dementia risk overall, and whether structurally minoritized groups (Black Americans, individuals from low childhood SES backgrounds, and people who grew up in rural areas or the South) differentially benefited (Aim 3). We will use data from Health and Retirement Study (HRS), the Reasons for Geographic and Racial Differences in Stroke cohort (REGARDS), and the National Longitudinal Survey of Youth, 1979 cohort to evaluate these aims. Our research team has previously published using all three data sets. Aim 1 will evaluate whether expansion of college access reduced ADRD risk; hypothesis 1 evaluates college geographic accessibility via increases in 2 and 4-year higher education institutions per capita, while hypothesis 2 evaluates college financial accessibility via a large social intervention that subsidized college education (the Vietnam War GI Bill). Aim 2 will evaluate whether policies that increased income security reduced ADRD risk; hypothesis 1 evaluates the long-term effects of a working age poverty-alleviation policy (the earned income tax credit), while hypothesis 2 evaluates retirement income security (Social Security). Aim 3 will evaluate whether the education and income security interventions examined in Aims 1 and 2 reduced socioeconomic, racial, and geographic disparities in ADRD; differential effects will be evaluated using interaction terms, quantile regression, and distributional decomposition. If our hypotheses are confirmed, results from this research will provide direct evidence for solutions to reduce the future population burden of ADRD and disparities in ADRD. Our work can also inform targeting of interventions to those who benefit most. This research will provide immediately actionable evidence, because the interventions we evaluate are specific and feasible.