# Using a Natural Experiment to Evaluate the Long-Term Effects of Neighborhood Deprivation on Alzheimer's Disease and Vascular Risk Factors

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2022 · $524,405

## Abstract

ABSTRACT
 The NIA has called for social science and community-based studies to clarify risk and protective factors for
Alzheimer's disease and related dementias (ADRD), particularly among racial minorities who are
disproportionately affected. Place, including both neighborhood of residence and region/state of birth, has
consistently been correlated with ADRD, stroke, and impaired cognitive function. Yet it is unclear whether
modifiable mechanisms explain this association, or whether the association is merely due to the selection of
unhealthy individuals into poor regions. The goal of this study is to produce the first quasi-experimental
evidence to understand the influence of neighborhood socioeconomic deprivation on ADRD and its vascular
risk factors. We take advantage of a unique natural experiment, overcoming methodological challenges in the
previous literature on neighborhood effects on ADRD. From 1986 to 1998, the Danish government actively
dispersed roughly 76,000 incoming refugees across the country in a nearly randomized (“quasi-random”)
fashion to avoid over-crowding in major cities. This cohort includes nearly 12,000 individuals who lived until at
least age 60 in Denmark during the 30-year follow-up. Over 90% of families agreed to participate in the
program, creating a natural experiment in which these individuals were quasi-randomly assigned to
neighborhoods with different levels of deprivation. We will employ unique data spanning over 30 years from
Denmark's population and clinical registers, which provide data on sociodemographics, clinical encounters,
and prescriptions for all Danish residents. We identify cases of ADRD and its vascular risk factors among this
racially diverse cohort via validated techniques using ICD codes and prescription data in clinical registers. We
have successfully linked these registers to detailed geocoded data sources on eight measures of
neighborhood socioeconomic deprivation. In Aim 1, our goal is to test the hypothesis that neighborhood
deprivation increases the incidence of ADRD later in life. In Aim 2, we will examine the effects of neighborhood
deprivation on vascular risk factors for ADRD, including highly prevalent conditions that occur across the life
course. In Aim 3, we will identify vulnerable subgroups whose development of ADRD and vascular risk factors
differs in response to neighborhood deprivation, taking advantage of the large sample size and complete
register data available on all subjects. We will employ both hypothesis-driven and hypothesis-generating
statistical techniques, including innovative machine learning methods that allow for more complex and robust
subgroup identification. This will enable future interventions to be tailored to the most vulnerable individuals.
Overall, the expected outcome of this research is to produce rigorous evidence on the effects of neighborhood
characteristics on ADRD and vascular risk factors, overcoming the methodological challenges in previous
work. ...

## Key facts

- **NIH application ID:** 10355477
- **Project number:** 5R01AG063385-04
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Rita Hamad
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $524,405
- **Award type:** 5
- **Project period:** 2019-05-01 → 2024-02-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10355477

## Citation

> US National Institutes of Health, RePORTER application 10355477, Using a Natural Experiment to Evaluate the Long-Term Effects of Neighborhood Deprivation on Alzheimer's Disease and Vascular Risk Factors (5R01AG063385-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10355477. Licensed CC0.

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