Social Mechanisms Underlying Sex/Gender Inequalities in Alzheimers Disease: An Intersectionality Approach

项目摘要/摘要 阿尔茨海默病(AD)是一种主要的公共卫生负担，对女性的影响不成比例。世界上的女性 美国经历了结构性障碍，这阻碍了他们获得促进健康的机会 和资源，这可能会对他们的AD风险产生负面影响。对于黑人女性来说，社会劣势 与女性有关的因素与黑人有关的因素进一步加剧了这一问题。几乎没有什么 这样做是为了了解这些结构性不平等与AD的性别/性别差异之间的联系。差异 男性和女性之间的差异被认为主要是生物上的(例如，由于性类固醇的影响 荷尔蒙)和社会驱动的女性异质性在很大程度上被忽视了。为了让这个领域向前发展， 对阿尔茨海默病性别/性别差异感兴趣的研究人员必须识别和理解阿尔茨海默病的结构性驱动因素 男女之间的认知健康不平等。这项研究计划的科学目标是 确定结构性决定因素是否影响AD结果中的性别/性别不平等。这个项目 应用交叉性方法，考察结构层次歧视的多种经验如何 和不平等(即结构性性别歧视、结构性种族主义)重叠和相互作用，产生不同的认知 非拉丁裔黑人和白人女性和男性的健康结果。目标1(K99)侧重于确定 州一级结构性性别歧视和种族主义对性别/性别之间认知轨迹的影响程度 种族团体。目标2(R00)建议调查认知储备中的性别/性别不平等是否存在差异 不同程度的结构性性别歧视和种族主义暴露。该建议利用了认知轨迹和AD- 来自华盛顿高地-因伍德五个队列和全国代表性纵向研究的生物标记物数据 社区老龄化项目(WHICAP)、子孙后代研究、少数民族老龄化研究(MARS)、健康和 退休研究(HRS)，以及中风地理和种族差异的原因(方面)。国家-- 将使用结构性性别歧视和种族主义的水平指标。将使用最先进的统计方法 来检查以前在公共卫生研究中使用但尚未被使用的交叉性 应用于纵向认知老化结果。这项研究计划得到了一项培训计划的补充 以候选人在认知老化、健康差距和高级统计方法方面的背景为基础 并包括(1)尖端分析交叉性技术、(2)测量和建模方面的新培训 健康的结构性决定因素，(3)AD生物标志物的性别/性别差异，以及(4)因果推断 方法：研究方法。综合的研究和培训计划将使申请者为成功的独立学习做好准备 研究生涯侧重于确定性别/性别不平等的宏观社会和生物决定因素 广告。

PROJECT SUMMARY/ABSTRACT Alzheimer’s disease (AD) is a major public health burden that disproportionately affects women. Women in the U.S. have experienced structural barriers, which prevent them from accessing health enhancing opportunities and resources, that may have a negative impact on their AD risk. For Black women, the societal disadvantages associated with being a woman are further compounded by those associated with being Black. Little has been done to understand the link between these structural inequalities and sex/gender differences in AD. Differences between men and women are assumed to be primarily biological in nature (e.g., due to effects of sex-steroid hormones) and socially driven heterogeneity among women has been largely ignored. To move the field forward, researchers interested in sex/gender differences in AD must identify and understand the structural drivers of cognitive health inequalities between men and women. The scientific objective of this research plan is to determine whether structural determinants influence sex/gender inequalities in AD outcomes. This project applies an intersectionality approach that examines how multiple experiences of structural-level discrimination and inequality (i.e., structural sexism, structural racism) overlap and interact to produce disparate cognitive health outcomes among non-Latinx Black and White women and men. Aim 1 (K99) focuses on determining the extent to which state-level structural sexism and racism influences cognitive trajectories among sex/gender-by- race groups. Aim 2 (R00) proposes to investigate whether sex/gender inequalities in cognitive reserve varies across levels of structural sexism and racism exposure. This proposal leverages cognitive trajectory and AD- biomarker data from five cohort and nationally representative longitudinal studies: Washington Heights-Inwood Community Aging Project (WHICAP), Offspring study, Minority Aging Research Study (MARS), Health and Retirement Study (HRS), and Reasons for Geographic and Racial Differences in Stroke (REGARDS). State- level indicators of structural sexism and racism will be used. State-of-the-art statistical methods will be employed to examine intersectionality that have been previously used in public health research, but that have not yet been applied to longitudinal cognitive aging outcomes. This research plan is complemented by a training plan that builds on the candidate’s background in cognitive aging, health disparities, and advanced statistical methods and includes new training in (1) cutting-edge analytic intersectionality techniques, (2) measuring and modeling structural determinants of health, (3) sex/gender differences in AD-biomarkers, and (4) causal inference methods. The combined research and training plans will prepare the applicant for a successful independent research career focused on identifying macro-social and biological determinants of sex/gender inequalities in AD.