Multi-Level Determinants of Sexual and Gender Minority Aging

项目摘要 在美国，有超过2000万的性和性别少数（SGM）成年人。SGM成人体验 严重的健康不平等，如阿尔茨海默病和相关痴呆症（ADRD）的风险较高， 慢性健康状况的流行和严重程度，以及多种癌症的较高风险。SGM歧视 可能会加速衰老，破坏预防性护理的使用，并在卫生系统正常运行时对卫生系统造成障碍。 病了总体目标是了解供应商和政策层面因素之间的关系， 中年和老年SGM成人的衰老和健康结果。在具体目标1中，我们将估计人口水平 主观认知下降（SCD）的患病率、SCD的严重程度以及SCD相关非正式护理的接受情况 使用2015-2019年行为风险因素监测系统（BRFSS）的数据进行评估。这是 性少数（SM）成人的最大概率样本，所有分析将按性别分层， 性取向首次出现在公共卫生研究中。我们假设SM成年人会报告更高的 SCD患病率和ADRD风险，但配偶或家庭成员提供的非正式护理较少。在 具体目标2，我们将研究7个供应商层面的态度和做法之间的关系，对SGM 患者和预防性保健使用（例如，接受结肠直肠癌检查、流感疫苗接种）和水平 认知障碍这一目标利用了来自NIA的关于中年和老年SGM成人的新面板数据， 资助的范德比尔特大学社交网络，老龄化和政策研究（VUSNAPS）。在具体目标3中，我们 估计国家政策在法律上允许基于性取向拒绝提供医疗服务的关联 以及SM成年人的预防性保健使用率、健康状况和健康行为。为此，我们 将使用BRFSS数据和差异中的差异设计来比较有和没有的州的SM成年人 法律的拒绝政策。结果对中年和老年SGM成年人有重要意义-NIA优先事项 人口通过使用可用的SM成年人的最大概率样本，我们能够按性别分层， 性取向这些细致入微的调查结果可能会为有关长期支持和服务的政策提供信息， 满足患有SCD相关损伤和ADRD风险升高的亚群的需求。此外，本发明的目的是， 我们使用SGM中年和老年人的新面板数据来确定预防保健的提供者水平预测因子。 研究见解可以为更大规模的干预提供信息，以改善SGM患者的态度和做法， 卫生系统一级。

Project Abstract There are over 20 million sexual and gender minority (SGM) adults in the United States. SGM adults experience significant health inequities such as higher risk for Alzheimer’s Disease and related dementias (ADRD), higher prevalence and severity of chronic health conditions, and higher risk for multiple cancers. SGM discrimination likely accelerates aging, disrupts use of preventive care, and creates barriers to health systems when they are sick. The overall objective is to understand the relationship between provider- and policy-level factors to improve aging and health outcomes of midlife and older SGM adults. In Specific Aim 1, we will estimate population-level prevalence of subjective cognitive decline (SCD), severity of SCD, and receipt of informal care for SCD-related impairments using data from the 2015-2019 Behavioral Risk Factor Surveillance System (BRFSS). This is the largest probability sample of sexual minority (SM) adults available and all analyses will be stratified by sex and sexual orientation for the first time in public health research. We hypothesize that SM adults will report higher SCD prevalence and ADRD risk, but lower access to informal care provided by a spouse or family member. In Specific Aim 2, we will examine the relationship between 7 provider-level attitudes and practices towards SGM patients and preventive healthcare use (e.g., receiving colorectal cancer screenings, flu vaccinations) and level of cognitive impairment. This aim leverages novel panel data on midlife and older SGM adults from the NIA- funded Vanderbilt University Social Networks, Aging, and Policy Study (VUSNAPS). In Specific Aim 3, we will estimate the association of state policies legally permitting denial of health services based on sexual orientation and rates of preventive healthcare use, health status, and health behaviors among SM adults. In this aim, we will use BRFSS data and a difference-in-differences design to compare SM adults in states with and without legal denial policies. Results have significant implications for midlife and older SGM adults — an NIA priority population. By using the largest probability sample of SM adults available, we are able to stratify by sex and sexual orientation. These nuanced findings may inform policies regarding long-term supports and services to meet the needs of sub-populations with both SCD-related impairments and elevated risk for ADRD. Additionally, we use novel panel data on SGM midlife and older adults to identify provider-level predictors of preventive care. Research insights may inform larger scale interventions to improve attitudes and practices with SGM patients at the health system-level.