Reducing racial disparities in AD/ADRD: Addressing structural discrimination and resilience

非裔美国人患阿尔茨海默病/阿尔茨海默病相关痴呆症（AD/ADRD）的可能性是白人的两倍多。这是一个可以预防的差距。这一LEADR提案的简单而创新的长期愿景是消除AD/ADRD负担中的种族差异。在这个项目中，我们将1）制定一个结构性歧视和弹性的措施，2）用它来预测AD/ADRD的结果，3）制定干预措施，以降低患病率和提高弹性。了解如何平衡黑人和白色AD/ADRD负担将揭示优化预防和护理的机制。有了历史数据、创新方法和解决这一差距的承诺，我们就能实现这一目标。AD/ADRD的功能影响从来不仅仅是由于个人的下降;它反映了一个人的下降，他们的补偿能力和环境需求之间的相互作用。补偿的弹性不仅仅是个人的问题，它有许多领域，包括使用剩余完整大脑功能的能力，应对技能，家庭支持，家庭的物理布局，以及多个社区和政策因素。虽然结构性歧视和复原力与AD/ADRD和功能有关，但目前没有衡量工具。我们将使用顺序探索混合方法仪器设计模型，其中研究人员将主要利益相关者纳入仪器设计过程。该工具将衡量结构性歧视和复原力以及家庭支持、绿色空间和社会联系的八个方面。整个生命周期的邮政编码将用于合并历史数据，以衡量多个风险或保护因素，如学区资金，环境毒素和可访问的绿地数量。我们将与老年人和研究人员一起构建该仪器，进行认知测试，试点测试，改进，然后在NIH支持的国家数据集中使用该仪器。干预措施制定阶段将包括：1）来自先前定性部分的见解; 2）数据收集阶段的结果; 3）来自决策者、研究人员、倡导者、AD/ADRD患者及其家人等更大利益相关者群体的见解，以审查结果并确定潜在的干预机制。这项工作计划将超越个人和家庭干预措施，以解决AD/ADRD的结构性决定因素。开发一种可靠、有效的结构性种族歧视测量方法，能够测试其在AD/ADRD中的作用，然后将其用作制定人群水平干预措施的框架，是一个高风险、高回报的目标--值得NIH在AD/ADRD中投资。一个重要的副作用是，由于与结构性歧视相关的许多其他疾病也在AD/ADRD的因果途径上，因此这项工作也将增强我们对高血压，中风，心脏病和其他炎症性疾病的理解。该项目利用申请人的独特优势，优秀的研究环境和现有的NIA资源，致力于解决家庭和社会税收的关键差距。

African Americans are more than twice as likely to have Alzheimer’s disease/Alzheimer’s disease related dementias (AD/ADRD) as Whites. This is a preventable gap. The simple yet innovative long-term vision of this LEADR proposal is to erase racial disparities in AD/ADRD burden. In this project, we will 1) develop a measure of structural discrimination and resilience, 2) use it to predict outcomes in AD/ADRD and 3) develop interventions to decrease prevalence and increase resilience. Understanding how to equalize the Black and White AD/ADRD burden will reveal mechanisms that will optimize prevention and care for all. With historical data, innovative approaches, and a commitment to addressing this disparity, we can achieve this objective. The functional impact of AD/ADRD is never due solely to individual decline; it reflects interactions between a person’s decline, their ability to compensate, and the demands of the environment. The resilience to compensate is not just an individual matter, it has many domains including the ability to use remaining intact brain function, coping skills, family support, physical layout of the home, and multiple community and policy factors. Although structural discrimination and resilience are relevant to AD/ADRD and function, there are currently no measurement instruments. We will use the sequential exploratory mixed methods Instrument Design Model in which researchers incorporate key stakeholders into the instrument design process. This instrument will measure eight dimensions of structural discrimination and resilience plus family support, greenspace, and social connection. Zip codes across the lifespan will be used to merge historical data to measure multiple risk or protective factors such as school district funding, environmental toxins, and amount of accessible greenspace. We will construct the instrument with older adults and researchers, cognitively test, pilot test, refine and then field the instrument in national datasets supported by the NIH. The intervention development stage will include: 1) insights from the previous qualitative portions; 2) results of the data collection phase; 3) insights from a larger stakeholder groups of policy makers, researchers, advocates, people living with AD/ADRD and their families to review findings and identify potential intervention mechanisms. This program of work will move beyond individual and family interventions to address the structural determinants of AD/ADRD. Developing a reliable, valid measure of structural racial discrimination, being able to test its role in AD/ADRD, and then to use it as a framework for developing population-level interventions, is a high-risk, high-reward goal - worthy of the NIH investment in AD/ADRD. A significant side benefit is that because many other conditions related to structural discrimination are also on the causal pathway to AD/ADRD, this effort will also enhance our understanding of hypertension, stroke, heart disease, and other inflammatory diseases. The project uses the distinct strengths of the applicant, the outstanding research environment, and existing NIA resources to work towards solving crucial disparities that tax families and society.