1. Sharpening a Focus on Race in Applied Research
Carl V. Hill, Ph.D., M.P.H.
Director, Office of Special Populations
National Institute on Aging 1

2. NIH Today Conducts research in its own laboratories
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4. NIA Mission Established in 1974 to support and conduct research on:
aging processes
age-related diseases
special problems and needs of the aged
Train and develop research scientists
Provide research resources
Disseminate information on health and research advances

5. NATIONAL INSTITUES OF HEALTH
National Institute on Aging Organizational Structure
Office of the Director
Richard J. Hodes, M.D.
Marie A. Bernard, M.D.
Intramural Research Program
Luigi Ferrucci, M.D., Ph.D.
Michele K. Evans, M.D.
Division of Extramural Activities
Robin Barr, D.Phil.
Sanoj Suneja, Ph.D.
Division of Aging Biology
Felipe Sierra, Ph.D.
Ronald Kohanski, Ph.D.
Division of Geriatrics and Clinical Gerontology
Evan Hadley, M.D.
Winifred K. Rossi, M.A.
Division of Behavioral and Social Research
John Haaga, Ph.D.
Dana Plude, Ph.D.
Division of Neuroscience
Eliezer Masliah, M.D.
Brad Wise, Ph.D.

6. AD/ADRD Targeted Increases $425 M in additional appropriations
National Alzheimer’s Project Act (NAPA)
$50 M* redirected within NIH budget
$40 M* redirected within NIH budget
$100 M additional approp
$25 M additional approp
$350 M additional approp
$400 M additional approp
$414 M additional approp
$425 M in additional appropriations
as of 09/28/18
*one-year money
Years displayed are Fiscal Years

7. Recruitment to a growing AD/ADRD workforce
Over 1/4 of NIA’s Alzheimer’s and related dementias awardees from Fiscal Year were either new or early stage investigators
Over 1/3 of NIA’s Alzheimer’s and related dementias awardees were new to the field

8. Alzheimer’s Disease and Related Dementias
African Americans are about twice as likely to have Alzheimer’s or other dementias as older whites.
Some studies indicate Hispanics are about one and one-half times as likely to have Alzheimer’s or other dementias as older whites
Genetic factors do not appear to account for differences in prevalence or incidence among racial groups.
(Alzheimer’s Association, 2019)

9. NIA Health Disparities Populations*
Blacks/African Americans
Hispanics/Latinos
American Indians/Alaskan Natives
Asian Americans
Native Hawaiians and Other Pacific Islanders
Socioeconomically Disadvantaged Populations
Rural Populations
Disability Populations
Sex and Gender Minorities (SGM)
*Public Law , Minority Health and Health Disparities Research and Education Act of 2000

10. NIA Health Disparities Research Framework
Priority Populations
Environmental
Levels of Analysis
Sociocultural
Biological
Behavioral
What are pathways among determinants that create and sustain health disparities?
Source: Hill, Perez-Stable, Anderson & Bernard, Ethnicity & Disease, 2015

11. Health Disparities Research Related to Aging
“The appearance of crime among the southern Negroes is a symptom of wrong social conditions – of a stress of life…To be a poor man is hard, but to be a poor… in a land of dollars is the very bottom of hardships” 
- W.E.B. DuBois
“The Souls of Black Folk”
1903

12. Diversity in ADRD Clinical Research Trials
Study
% African
American
Purpose of Study
Cache County Study on Memory in Aging
<1
To explore the relationship between age-related cognitive and motor decline and the risk of AD
ADNIGO
3.1
To examine biomarkers in early stage of AD progression by including early MCI
ADNI-2
4.3
To develop CSF, blood, and imaging biomarkers as predictors of cognitive decline and outcome measures
ADNI-1
4.8
To develop CSF, blood, and imaging biomarkers as outcome measures using national cohort subjects
WHI-Cog
7.0
To explore the causal relationship between depressive symptoms in postmenopausal women and MCI/dementia
Mayo Clinic Study of Aging
<7.1
To establish a population-based cohort for studying the prevalence, incidence, and risk factors of MCI and dementia
DoD-ADNI
7.1
To use imaging/biomarkers to establish the biological connections between TBI, PTSD and AD in Vietnam War veterans
SPRINT-MIND
29.9
To examine the role of risk factors for AD on its progression and late-life cognitive decline in a 12-year longitudinal study
WHICAP
34.6
To use imaging biomarkers to compare brain region volumes among multiethnic cognitively normal elderly
Well…while we know that the intersection of (right hand) acquiring health protecting resources and (left hand) experiencing hardship, bias and discrimination might point directly to African Americans as a priority health disparities population for ADRD…this has yet to be confirmed by researchers…for a number of reasons.
First…an initial push to understand Alzheimer’s Disease and Related Dementias has somewhat understandably focused on understanding risk factors for the population at large…
And we also know that the measurement of Alzheimer’s Disease has stirred quite debate…possibly causing inconsistencies in reported prevalence for various demographic populations…
But as we see in the slide…and probably most important… is the varied and mostly low percentages of African Americans that are enrolled and retained in ADRD Clinical Trials.
Pay off: In addition thinking about health disparities research that explores the role of environmental and social resources…the NIA has been interested in understanding ways to best recruit cohorts for ADHD Clinical Trials that are diverse…and permits population comparisons and ultimately health disparities research
Source: Shin & Doraiswamy, Frontiers in Aging Neuroscience, 2016

13. Sharpening a Focus on Race – Next Steps
Diverse Recruitment/Retention (Outreach, Engagement)
Locating Pathways from Environmental to Biological Factors for Racial/Ethnic Populations – Culture, Collective Responses
Leveraging Analytic Methods to Expand Opportunities in Aging-related Health Disparities Research
Interdisciplinary Team Science that includes Basic Scientists
Identifying “malleable” intervention targets along these pathways
…well interestingly enough, there is a emerging (NOT NEW) science here at NIH that allows for a systematic, congressionally mandated… assessment of health differences by social class, race, ethnicity and geography…called health disparities research. Early findings indicate that:
Environmental
Sociocultural
Behavioral
…and biological factors are critical for understanding and addressing health disparities.
However, relationships between these factors are not as clearly understood.
How do environmental, sociocultural, behavioral and biological factors link to sustain health disparities?
What phenomena might help us make connections and theorize pathways?

14. NIA Health Disparities Research Framework. www
NIA Health Disparities Research Framework
Showcases NIA-funded research projects that address health disparities related to aging
Potential applicants are able to peruse NIA priorities and investments in this important area of aging research
This tool also includes links to keystone papers and current related funding opportunities

15. CONTACT
Carl V. Hill, Ph.D., M.P.H. Director, Office of Special Populations National Institute on Aging (NIA) National Institutes of Health (NIH)