# Multilevel Forms of Structural Racism and Racial Inequalities in ADRD Risk

> **NIH NIH R01** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2022 · $720,008

## Abstract

Project Summary/Abstract
Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (AD/ADRD) are on the rise in the United
States. Estimates project a 40% increase in AD among older Americans by 2025. This increase, along with its
associated economic, social, and health burdens, are likely to have disproportionate impacts, as Black adults
have the highest incidence of dementia of any racial/ethnic group in the U.S. Moreover, Black Americans
experience higher rates of established biological risk factors for AD/ADRD, including hypertension, diabetes,
stroke, inflammation, and biological aging. The expected growth in AD diagnoses, expenditures, and burdens,
as well as potentially widening racial inequalities, make it imperative to investigate early risk factors for the
development of AD/ADRD and racial inequalities in AD/ADRD. Structural forms of racism are likely important
drivers of racial inequalities in AD/ADRD risk. Yet, much of the research in this area focuses on downstream
factors, such as exposure to stressors and discrimination, or specific domains of structural racism at one point
in time. Missing are longitudinal studies of structural racism and aging-related health inequalities across
multiple geographic contexts. Further, there is limited knowledge of how public health and policy interventions
addressing structural racism can be utilized to reduce racial inequalities in AD/ADRD. Causal modeling
techniques provide opportunities to assess the impact of structural interventions on documented inequalities in
biological risk factors for AD/ADRD using observational data. The purpose of this project is twofold: 1) to create
a public-use, comprehensive data repository of multilevel and repeated contextual measures of structural
racism; and 2) use the new contextual data in combination with existing contextual and individual-level
longitudinal data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to examine
specific pathways linking structural racism and AD/ADRD biological risk among early midlife U.S. adults.
Specifically, we will investigate whether structural racism across educational, residential, and criminal justice
contexts independently and jointly shape Black-White disparities in biological risk factors for AD/ADRD,
including hypertension, diabetes, inflammation, epigenetic aging, and two novel biomarkers of AD/ADRD risk
(neurofilament light and total tau). We will also use simulation models to compare the effects of hypothetical
population-based policy changes and targeted interventions on racial inequalities in biological risk factors of
AD/ADRD risk. Findings from this study will advance our understanding of how structural racism shapes
AD/ADRD risk early in the life course. Results from simulation models will also inform the development of
population-level, early interventions aimed to slow the progression of AD/ADRD risk and reduce health
inequalities in these outcomes.

## Key facts

- **NIH application ID:** 10474847
- **Project number:** 1R01AG077947-01
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** TAYLOR HARGROVE
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $720,008
- **Award type:** 1
- **Project period:** 2022-07-01 → 2027-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10474847

## Citation

> US National Institutes of Health, RePORTER application 10474847, Multilevel Forms of Structural Racism and Racial Inequalities in ADRD Risk (1R01AG077947-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10474847. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*