Alzheimer’s Disease and Related Dementias in The Most Incarcerated Generation: An Understudied Population with Health Disparities

建议的项目，响应NOT-AG-21-033（健康差异和阿尔茨海默病），是 第一次纵向和流行病学调查司法参与和痴呆症。的美国人 体验正义的参与，从社区到监禁，从监禁回到 社区，正在迅速老化。此外，司法参与不成比例地影响有色人种和 社会经济地位低的人，他们也有患各种形式痴呆症的高风险，但经常被排除在 痴呆症相关的研究这项研究将有助于我们了解痴呆症的健康差异， 评估监禁、痴呆和一些重要社会风险因素之间的相互关系 和多发病因素随着时间的推移在一个国家的样本。我们将优化退伍军人健康 政府（VHA）从医疗保险中心和 医疗补助服务（CMS）。我们建议利用纵向“监狱释放”队列， 一项不同的NIH资助的研究和补充（R 01 MH 117604和S1）。该群体包括> 30，000人 参加Medicare和VHA的个人，年龄≥50岁（2008-2018年）重新进入社区 在监禁之后。我们将加强这一队列，以包括2008年至2010年期间年龄≥50岁的所有退伍军人。 到2022年，包括在这一时间范围内任何时候被监禁和被释放的人， 仍然被监禁（没有重返社区），以及那些从未被监禁的人，总数超过46，000人 1050万退伍军人中的司法参与退伍军人。使用这个丰富的纵向数据集，我们有 前所未有的机会，以制定社会风险因素概况和与风险相关的多种发病率概况 痴呆症患者中的监禁风险（目标1）和痴呆症患者中的释放风险 监禁（目标2）。获得VA和Medicare数据提供了更完整的结果确定，因此 增加了确定这些谱是否根据痴呆亚型而不同的机会（例如， 阿尔茨海默病、血管性、额颞、轻度认知障碍（MCI））。我们还将利用新的 以评估经历不同路径的概率（例如，进入途径 监禁，从监禁中释放，发展痴呆症），并确定 预测这些路径（目标3）。我们将评估健康差距人群中的所有目标，如非 西班牙裔黑人、西班牙裔、原住民/土著群体和那些经历贫困指标的人（例如， 无家可归和处于不利社会经济地位）。这项研究具有重大的公共卫生意义。它将 降低痴呆症患者进入监禁风险的知情策略，将描述那些最高的 监禁后患痴呆症的风险，以便为监狱到社区的过渡性护理规划提供信息， 并将确定优化痴呆症护理可以减少健康差距的主要干预点 在有正义参与的人和没有正义参与的人之间，甚至在正义参与的人内部。

The proposed project, which responds to NOT-AG-21-033 (Health Disparities and Alzheimer’s Disease), is the first longitudinal and epidemiological examination of justice-involvement and dementia. Americans who experience justice-involvement, moving from the community to incarceration and from incarceration back to the community, are aging rapidly. Moreover, justice-involvement disproportionately impacts persons of color and of low socioeconomic status, who are also at high risk for all forms of dementia yet are frequently excluded from dementia-related research. This study will contribute to our understanding of health disparities in dementia by evaluating the inter-relationship among incarceration, dementia, and a number of important social risk factors and multi-morbidity factors over time in a national sample. We will optimize the Veterans Health Administration’s (VHA) capacity to access Incarceration History Files from the Centers for Medicare and Medicaid Services (CMS). We propose to leverage a longitudinal “prison release” cohort which we created for a different NIH-funded study and supplement (R01 MH117604 and S1). This cohort includes >30,000 individuals enrolled in both Medicare and VHA, who reentered the community at age ≥50 (between 2008-2018) following an incarceration. We will enhance this cohort to include all veterans who were age ≥50 between 2008 to 2022, including those incarcerated at any point during that timeframe and who were released, those who remained incarcerated (no community reentry), and those never incarcerated, for a total of more than 46,000 justice-involved veterans among 10.5 million veterans. Using this rich, longitudinal dataset, we have the unprecedented opportunity to develop social risk factor profiles and multi-morbidity profiles associated with risk of incarceration among those with dementia (Aim 1) and risk of dementia among those released from incarceration (Aim 2). Access to VA and Medicare data provides more complete outcome ascertainment, thus increasing the opportunity to determine if these profiles differ according to dementia subtypes (e.g., Alzheimer’s Disease, vascular, frontotemporal, mild cognitive impairment (MCI)). We will also make novel use of transition models to evaluate probabilities of experiencing distinct pathways (e.g., pathway to entering incarceration, to being released from incarceration, to developing dementia) and determine precursors that predict these pathways (Aim 3). We will evaluate all Aims within health disparity populations such as non- Hispanic Black, Hispanic, native/indigenous groups and those experiencing indicators of poverty (e.g., homelessness and socioeconomic disadvantage). This study has substantial public health significance. It will inform strategies to mitigate risk of patients with dementia entering incarceration, will delineate those at highest risk of developing dementia after incarceration so as to inform prison-to-community transitional care planning, and will identify prime intervention points where optimizing dementia care could reduce health disparities between those with and without justice-involvement and even within the justice-involved.