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Cumulative socioeconomic exposures, cash transfer interventions, and later-life cognitive decline and dementia risk in a low-income region of South Africa

Award Number: R01AG069128
ORGANIZATION: NATIONAL INSTITUTE ON AGING
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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PROJECT SUMMARY By 2050, 75% of Alzheimer’s disease and related dementias (ADRD) cases will occur in low- and middle-income regions, like rural South Africa, which are severely under-represented in ADRD research. There is a critical evidence gap on the role of socioeconomic status (SES) in ADRD etiology in low-income settings, and how SES can best be targeted by interventions to prevent and/or delay ADRD onset. Our long-term goal is to inform the design of gender-equitable SES interventions to prevent and/or delay ADRD onset in low-income settings. The objective of this proposal is to identify how SES affects ADRD risk, using longitudinal exposures (household assets, food security, and employment) and randomized and quasi-randomized cash transfer exposures accumulated over time in mid-to-later-life in rural South Africa. Our central hypothesis is that greater cumulative exposure to advantageous socioeconomic conditions will protect against ADRD, with differential effects for men and women for household-level SES resources that may not be equally allocated between genders. To test this central hypothesis, we will leverage a unique opportunity to create one of the first longitudinal data platforms to study ADRD risk in Africa: we will link high-quality memory and ADRD outcome data collected from 2015-21 in the population-representative “Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa” (HAALSI; N=5059) to detailed SES exposure data collected since 2000 in the “Agincourt Health and Sociodemographic Surveillance System” (AHDSS; a census with 100% population coverage) and the HPTN 068 randomized controlled trial of cash transfers to households from 2011-15 (N=863 households in both HPTN 068 and HAALSI). These three datasets can be linked because the AHDSS census is the sampling frame for HAALSI and HPTN 068; we have confirmed linkage feasibility in our preliminary data. Specifically, we aim to: 1) Determine the roles of mid-to-later life cumulative household assets, employment, and food security (2000-13; AHDSS) in memory decline and ADRD risk (2015-21; HAALSI); 2) Determine whether exposure to cash transfer interventions affect memory decline and ADRD by leveraging 2a) randomized cash transfers in HPTN 068; 2b) expansion of the South African Old Age Pension for men; 2c) expansion of the South African Child Support Grant for mothers; and 3) Determine how gender modifies the effects of household-level SES exposures in Aims 1 & 2a. This proposal is innovative because the study population of older, rural Black South African adults improves representation of understudied groups in ADRD research; our longitudinal assessments of SES exposures over 14 years improve upon the status quo of SES measured retrospectively or at single points in time; and our linkage of the HAALSI cohort to a randomized controlled cash transfer trial and data on national social protection policies allows causal inference about income and ADRD risk. This proposal is a major opportunity for life course research in a rapidly aging, low-income population that can provide insights into ADRD etiology and strategies to prevent and/or delay ADRD onset in global low-income settings, where there is little data outside this study.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2023 ( Subtotal = $465,673 )
2023	2023	TRUSTEES OF INDIANA UNIVERSITY	107 S INDIANA AVE	BLOOMINGTON	IN	47405	MONROE	USA	Aging Research	000	4	5/22/2023	NON-COMPETING CONTINUATION	$465,673
														Subtotal = $465,673

Issue Date FY: 2022 ( Subtotal = $517,630 )
2022	2022	TRUSTEES OF INDIANA UNIVERSITY	107 S INDIANA AVE	BLOOMINGTON	IN	47405	MONROE	USA	Aging Research	000	3	5/27/2022	NON-COMPETING CONTINUATION	$517,630
														Subtotal = $517,630

Issue Date FY: 2021 ( Subtotal = $457,042 )
2021	2021	TRUSTEES OF INDIANA UNIVERSITY	107 S INDIANA AVE	BLOOMINGTON	IN	47405	MONROE	USA	Aging Research	000	2	6/10/2021	NON-COMPETING CONTINUATION	$457,042
														Subtotal = $457,042

Issue Date FY: 2020 ( Subtotal = $586,198 )
2020	2020	TRUSTEES OF INDIANA UNIVERSITY	107 S INDIANA AVENUE	BLOOMINGTON	IN	47405	MONROE	USA	Aging Research	000	1	9/10/2020	NEW	$586,198
														Subtotal = $586,198

Grand Total All Awards = $2,026,543

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Cumulative socioeconomic exposures, cash transfer interventions, and later-life cognitive decline and dementia risk in a low-income region of South Africa

Award Number: R01AG069128

ORGANIZATION: NATIONAL INSTITUTE ON AGING

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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