Racial Disparities in Alzheimer's Disease and Related Dementias: The Role of School Segregation and Experiences of Discrimination

项目总结 阿尔茨海默病和相关痴呆症(ADRDS)是一个主要的公共卫生负担，而且 影响黑人个体。尽管社会经济和心血管风险因素是造成这种情况的部分原因， 结构性(如学校隔离)和人际种族主义(如歧视)的经历可能是 认知不平等的重要驱动因素。学校种族隔离的种族主义经历可能会无处不在 因应激反应激活对持续性歧视事件和不良健康结局的影响 此外，社会经济机会减少，这可能导致ADRDS风险增加。有限 关于学校隔离对晚年认知结果的影响的研究得出了不同的结论和 没有考虑事件痴呆的风险。此外，以前的研究没有考虑中老年。 学校隔离之间的联系的调解人或量化学校隔离的时间。因此， 这项拟议研究的基本原理是描述学校隔离和由此产生的 人际歧视在ADRDS风险上的经验解释为什么黑人个体有更高的 与其他种族和民族群体相比，ADRDS造成的负担更大，并确定预防ADRDS和 减少ADRDS的差异(例如，减少种族主义的组织和职业政策)。分析将会 利用非裔美国人和Kaiser的健康老龄化研究健康老龄化和多样化生活 经验，NIA资助的美国老年人口纵向队列。整体而言 这项申请的目的是检查学校隔离对老年人ADRDS不平等的影响 黑人和白人成年人(50-89岁)。该项目还将讨论歧视的经历如何 生命周期影响认知轨迹和ADRDS风险。具体地说，这项研究将评估这种联系 在黑人中接受种族隔离的学校学习认知能力下降和ADRDS风险之间的关系 个人(目标1)，并评估日常和重大生活歧视作为这方面的调解人的作用 协会(目标2)。最后，这项拟议的研究将估计种族认知差异的程度。 下降和ADRDS风险是由每天不同的学校隔离风险造成的 对黑人和白人个人的歧视和主要的生活歧视(目标3)。检视 在一大群不同的黑人和白人人群中，社会背景因素对ADRDS风险的影响将提供 对结构性和人际种族主义对ADRDS风险的持续影响的宝贵见解，并将提供信息 减少ADRDS不平等的人口干预措施，包括针对中间体或近端 机制(例如，改善社区和教育质量，增加获得额外收入的机会和 就业机会)。拟议的培训由模范导师团队指导，将加强 申请人的方法技能、研究能力和作为职业生涯所需的内容专业知识 未来ADRDS的独立研究人员将重点放在减少种族不平等的战略上。

PROJECT SUMMARY Alzheimer’s disease and related dementias (ADRDs) are a major public health burden and disproportionately affect Black individuals. Although socioeconomic and cardiovascular risk factors partially account for this, experiences of structural (e.g. school segregation) and interpersonal racism (e.g. discrimination) could be important drivers of cognitive inequities. The racialized experience of school segregation can have pervasive effects on sustained discriminatory events and poor health outcomes because of stress-response activation, in addition to decreased socioeconomic opportunities, which may contribute to increased ADRDs risk. Limited studies on the impact of school segregation on late-life cognitive outcomes have produced mixed findings and did not consider incident dementia risk. Additionally, prior studies have not considered mid or late-life mediators of the association between school segregation or quantified the timing of school segregation. Thus, the rationale for the proposed research is to delineate the association of school segregation and resulting experiences of interpersonal discrimination on ADRDs risk to explain why Black individuals have a higher ADRDs burden than other racial and ethnic groups and to identify potential strategies to prevent ADRDs and reduce ADRDs disparities (e.g. organization and occupational policies to reduce racism). The analysis will leverage the Study of Healthy Aging in African Americans and Kaiser Healthy Aging and Diverse Life Experiences, NIA-funded longitudinal cohorts of older adult populations in the United States. The overall objective of this application is to examine the effect of school segregation on ADRDs inequities among older Black and White adults (ages 50-89). This project will also address how experiences of discrimination across the lifecourse impact cognitive trajectories and ADRDs risk. Specifically, this study will evaluate the association between attendance at a racially segregated school on cognitive decline and ADRDs risk among Black individuals (Aim 1) and evaluate the role of everyday and major life discrimination as mediators of this association (Aim 2). Finally, the proposed study will estimate the extent to which racial differences in cognitive decline and ADRDs risk are contributed by differential exposure to school segregation, everyday discrimination, and major life discrimination among Black and White individuals (Aim 3). Examining the roles of sociocontextual factors on ADRDs risk in a large, diverse cohort of Black and White individuals will provide valuable insight into the sustained effects of structural and interpersonal racism on ADRDs risk and will inform population interventions to reduce ADRDs inequities including the targeting of intermediate or proximal mechanisms (e.g. improving neighborhood and educational quality, enhancing access to additional income and employment opportunities). The proposed training, guided by an exemplary mentorship team, will enhance the applicant’s methodological skills, research competency, and content expertise needed for her career as a future independent researcher in ADRDs focused on strategies to reduce racial inequities.