Examining school, neighborhood, and regional characteristics associated with VCID and stroke in the REGARDS study - The development of neurological conditions as people age is a major public health issue. While many individual risk factors have been identified as predictors of both vascular contributions to cognitive impairment and dementia (VCID), as well as stroke, these individual factors do not fully explain the likelihood of developing these outcomes. School, neighborhood, and regional characteristics are three factors hypothesized to be important in the development of VCID and stroke, yet few studies exist in this area. Across the disciplines of chronic disease, life course, and spatial epidemiology, a unique opportunity emerges to address this critical gap. This study leverages an ongoing, large-scale, population-based study: The REGARDS Study. REGARDS is a national sample of over 30,000 adults (45 years and older). The proposed study leverages the longitudinal assessments of both VCID and stroke in this cohort, and other retrospective and prospective data related to biological, clinical (e.g., vascular health conditions), behavioral (e.g., health behaviors), social (e.g., support, networks), and built and social environment factors across multiple levels of influence (e.g., individual, interpersonal, regional) collected through the parent study and two ancillary studies. These data include state- based and school-level school measures for each school participants attended; objective, county-level educational quality measures for each year of schooling; participant residential information that will be used to create life course measures of exposures to regional characteristics (median of 51 years); and several measures of neighborhood exposures (i.e., food retail, parks, healthcare facilities, social engagement, and social service institutions) for over 40,000 geocoded locations in middle and older ages. The proposed study will expand upon the existing sample, through creating school, neighborhood, and regional exposure measures that incorporate additional locations and years of data. The proposed study aims to: 1) Determine the association between school characteristics and VCID and stroke later in life and test the potential mediating role of educational quality, 2) Examine the association between regional characteristics over the life course and VCID and stroke, and 3) Explore features of the residential neighborhood and interpersonal factors that may mediate the link between regional characteristics in middle and older ages and VCID and stroke. This state-of-the-art study will establish the pathways through which school, neighborhood, and regional characteristics contribute to VCID and stroke, determine protective factors, and identify potential points of intervention.
