Identifying and Addressing Social Determinants of Health to Reduce the National Burden of and Inequities in Dementia

项目总结/摘要 阿尔茨海默病和相关痴呆症（ADRD）是一个不断升级的国家危机， 包括平均预期寿命。关键是，为了有效应对这场危机， 我们必须确定其根本原因，其中可能包括健康的社会决定因素，如 教育支出和社会流动性，我们通过相应的政策改变这些根源。 虽然少数SDoH已被证明可以预测认知能力下降和ADRD，但重要的问题仍然存在 关于哪些SDoH是根本社会驱动因素，即，有最大的影响。尽管越来越多的人呼吁 比较评估，以解开和解决ADRD的根本原因-社会决定因素，我们缺乏 了解与修改SDoH相关的相对ADRD负担和经济影响，包括 社会保障福利税等政策。此外，我们还没有确定 受SDoH影响最大。鉴于这些信息，迫切需要准确估计SDoH的影响， 并将这些估计转化为确定优先事项的工具，包括对ADRD的影响 负担和费用。如果这些关键需求得不到解决，将阻碍政策的制定， 有效减少ADRD负担和不公平现象。我们的总体目标是使用大型多层次，纵向 数据集和准实验方法构建第一个比较评估证据 基于ADRD负担和不公平的社会驱动因素。我们将实现我们的总体目标， 使用50岁以上成年人的数据，实现以下具体目标： 在美国社区研究，链接到国家死亡率数据库;全国代表性的健康和 退休研究，与医疗保险索赔数据有关;和NIH的所有人计划，一项多种族研究， 关于健康状况诊断/治疗的电子健康记录（EHR）数据：目的1）评估 地区级SDoH的影响，包括国家政策作为ADRD死亡率的保护因素， 可能因健康差异人群而异;目的2）评估地区级SDoH对 中年人记忆力下降，老年人认知障碍和痴呆的发病率 目的3）探讨区域性SDoH预防ADRD的机制 发病率和认知障碍/衰退，包括身体/精神健康障碍和生物标志物; 及目的4）确定哪些地区的自订卫生措施，如经修订，预期可达致最大的减排效果 ADRD负担和成本的水平和不公平性。关于影响，我们将确定最有希望的 SDoH上进行干预，以产生ADRD负担和不公平的改善。我们将进一步建立 按亚群体划分的不同脆弱性的途径。通过将估计数转化为人口健康指标， 我们预计，我们的项目将通过指导决策者的循证决策， 关于政策的决定，以更有效地减少美国人在ADRD中的负担和不平等。

PROJECT SUMMARY/ABSTRACT Alzheimer’s disease and related dementias (ADRD) are an escalating national crisis that shapes overall levels of population health including average life expectancy. Critically, in order to effectively address this crisis, it is imperative that we identify its root causes, which may include social determinants of health (SDoH) such as education spending and social mobility, and that we modify these root causes through corresponding policies. While a handful of SDoH have been shown to predict cognitive decline and ADRD, important questions remain about which SDoH are root social drivers i.e., have the greatest impacts. Despite increasing calls for comparative assessments to unpack and address the root causes—the social determinants—of ADRD, we lack knowledge on the relative ADRD burden and economic impacts associated with modifying SDoH, including policies such as the social security benefits tax. Furthermore, we have yet to establish which subpopulations are most affected by SDoH. Given this information, there are critical needs to accurately estimate SDoH impacts, including by subpopulation; and to translate these estimates into priority-setting tools including impacts on ADRD burden and costs. Left unaddressed, these critical needs will hinder the development of policies to more effectively reduce ADRD burden and inequities. Our overall objective is to use large multilevel, longitudinal datasets and quasi-experimental approaches to construct the first comparative assessment evidence base on the social drivers of ADRD burden and inequities. We will accomplish our overall objective by pursuing the following specific aims using data in adults age 50+ from: the nationally-representative Mortality Disparities in American Communities Study, linked to national mortality databases; the nationally-representative Health and Retirement Study, linked to Medicare claims data; and the NIH’s All of Us Program, a multiethnic study linked to electronic health records (EHR) data on diagnoses/treatments of health conditions: Aim 1) To assess the impacts of area-level SDoH including state policies as protective factors against ADRD mortality, that may vary across health disparity populations; Aim 2) To evaluate the impacts of area-level SDoH on memory decline in middle-aged adults and incidence of cognitive impairment and dementia in older adults; Aim 3) To explore the mechanisms through which area-level SDoH may protect against ADRD incidence and cognitive impairment/decline, including physical/mental health disorders and biomarkers; and Aim 4) To ascertain which area-level SDoH, if modified, are expected to yield the greatest reductions in levels of and inequities in ADRD burden and costs. Regarding impact, we will identify the most promising SDoH on which to intervene to yield improvements in ADRD burden and inequities. We will further establish the pathways to differential vulnerabilities by subpopulation. By translating estimates into population health metrics, we anticipate our project will have high translational impact through guiding policymakers' evidence-based decisions about policies to more effectively reduce the burden of and inequities in ADRD among Americans.