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

抽象的。阿尔茨海默病和相关疾病(ADRD)是美国主要的死亡原因 这些州对受教育程度和收入较低的个人的影响不成比例。有确凿的证据表明 整个生命过程中的社会经济地位强烈地影响着ADRD。然而，以前的工作几乎没有 评估旨在提高社会经济地位的社会经济干预措施是否能减少人口负担 如果有不同的社会人口子组的影响，导致较小的差距；这 该提案解决了文献中的这一关键差距。我们评估了增加的社会经济干预措施 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对痴呆症产生影响 总体风险，以及结构上的小规模群体(美国黑人，来自低童年SES的个人 在农村地区或南方长大的人)受益程度不同(目标3)。我们将使用 来自健康和退休研究(HRS)的数据，中风地理和种族差异的原因 队列(有关)，和1979年全国青年纵向调查的队列，以评估这些目标。我们的 研究团队之前使用了所有三个数据集发表了这一研究。目标1将评估是否扩大 大学入学降低了ADRD风险；假设1通过增加2来评估大学的地理可及性 和人均4年高等教育机构，而假设2评估的是大学的经济可获得性 通过资助大学教育的大规模社会干预(越战退伍军人法案)。AIM 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(劳动所得税收抵免)，而假设2评估 退休收入保障(社会保障)。目标3将评估教育和收入保障 目标1和目标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、分位数回归和分布来评估 腐烂。如果我们的假设得到证实，这项研究的结果将为 减少ADRD未来人口负担和ADRD差距的解决方案。我们的工作也可以告诉我们 将干预的目标对准那些受益最大的人。这项研究将立即提供可行的证据， 因为我们评估的干预措施是具体的和可行的。

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.