The Influence of Structural Racism on Incidence of Alzheimer's Disease and Related Dementias (ADRD) in Black women

摘要 阿尔茨海默氏病和相关痴呆症（ADRD）不成比例地影响美国黑人， 白色美国人。结构性种族主义-社会助长种族歧视和 白色至上通过在住房、教育、就业、卫生等方面相互加强的不平等制度 护理、刑事司法和其他领域-可能会导致社会风险因素和合并症的出现 增加ADRD的风险。结构性种族主义助长种族主义的机制和途径 美国黑人的ADRD在很大程度上尚未探索。我们建议评估结构的影响， 种族主义对美国黑人妇女这一高危人群ADRD发病率的影响。我们的研究将基于 参与者和来自美国各地59，000名黑人妇女的26年随访研究的数据，黑 妇女健康研究。我们将制定一项更全面的结构性种族主义措施 比大多数目前使用的和测试的特点，这一措施对那些几个公布的 在县和州一级采取措施。我们的新衡量标准将使用失业、贫困、 教育和监禁;其发展所需的数据将通过将参与者的 从1995年至2021年的地理编码地址到适当的公共数据来源。我们会找出 通过已经开发和测试的方法将65岁及以上的BWHS参与者与 2008-2022年的医疗保险数据;这将产生估计15,000年至2022年的1,500例ADRD事件病例。 16，000名BWHS参与者。自1995年加入BWHS以来，参与者提供了 对大量的健康和其他因素，其中包括潜在的风险因素（例如，高血压，糖尿病， 教育水平低）和保护因素（例如，运动、社会支持）。该研究收集了 在三个不同的时间对人际种族主义的感知经验的信息，这些报告 这些经历与不良健康结果的风险增加有关（例如，体重增加）， BWHS，如预期。这样，就有可能评估结构性种族主义本身对种族歧视发生率的影响。 ADRD以及结构性和人际间种族主义的综合影响。我们还将研究适度或 许多其他因素对结构性种族主义与种族歧视发生率之间关系的影响起中介作用， ADRD。由于数据是在26年的时间里在美国各地的地理区域收集的，将 有可能评估结构性种族主义对县和州ADRD发病率随时间和地点的影响 水平因此，拟议的研究将提供新的和重要的信息，结构性种族主义和反种族歧视， 黑人女性

ABSTRACT Alzheimer’s Disease and related dementias (ADRD) disproportionately affect Black Americans compared to White Americans. Structural racism – the totality of ways by which society fosters racial discrimination and White supremacy through mutually reinforcing, inequitable systems in housing, education, employment, health care, criminal justice and other domains – may drive the constellation of social risk factors and comorbidities that increase the risk of ADRD. The mechanisms and pathways by which structural racism contributes to ADRD in Black Americans are as yet largely unexplored. We propose to assess the influence of structural racism on incidence of ADRD in a high-risk group of Americans, Black women. Our study will be based on participants and data from a 26-year follow-up study of 59,000 Black women from across the U.S., the Black Women’s Health Study (BWHS). We will develop a measure of structural racism that is more comprehensive than most currently in use and test characteristics of this measure against those of several published measures, at the county and state level. Our new measure will use data on unemployment, poverty, level of education, and incarceration; the data needed for its development will be obtained by linking participants’ geocoded addresses from 1995-2021 to appropriate public data sources. We will identify incident cases of ADRD through an already developed and tested method of linkage of BWHS participants aged 65 and older to Medicare data for the years 2008-2022; this will yield an estimated 1,500 incident cases of ADRD in 15,000 to 16,000 BWHS participants. Since enrollment in the BWHS in 1995, the participants have provided information on a large number of health and other factors, which include potential risk factors (e.g., hypertension, diabetes, low level of education) and protective factors (e.g., exercise, social support) for ADRD. The study has collected information at three different times on perceived experiences of interpersonal racism, and these reported experiences have been associated with increased risk of adverse health outcomes (e.g., weight gain) in the BWHS, as expected. Thus, it will be possible to assess the effects of structural racism alone on incidence of ADRD as well as the combined effects of structural and interpersonal racism. We will also study moderation or mediation of effects by a large number of other factors on the association of structural racism with incidence of ADRD. Since data have been collected over a period of 26 years in geographic areas across the U.S., it will be possible to assess effects of structural racism on ADRD incidence over time and place at the county and state level. Thus, the proposed study will provide new and important information on structural racism and ADRD in Black women.