# Social Mechanisms Underlying Sex/Gender Inequalities in Alzheimers Disease: An Intersectionality Approach

> **NIH NIH K99** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2022 · $130,842

## Abstract

PROJECT SUMMARY/ABSTRACT
Alzheimer’s disease (AD) is a major public health burden that disproportionately affects women. Women in the
U.S. have experienced structural barriers, which prevent them from accessing health enhancing opportunities
and resources, that may have a negative impact on their AD risk. For Black women, the societal disadvantages
associated with being a woman are further compounded by those associated with being Black. Little has been
done to understand the link between these structural inequalities and sex/gender differences in AD. Differences
between men and women are assumed to be primarily biological in nature (e.g., due to effects of sex-steroid
hormones) and socially driven heterogeneity among women has been largely ignored. To move the field forward,
researchers interested in sex/gender differences in AD must identify and understand the structural drivers of
cognitive health inequalities between men and women. The scientific objective of this research plan is to
determine whether structural determinants influence sex/gender inequalities in AD outcomes. This project
applies an intersectionality approach that examines how multiple experiences of structural-level discrimination
and inequality (i.e., structural sexism, structural racism) overlap and interact to produce disparate cognitive
health outcomes among non-Latinx Black and White women and men. Aim 1 (K99) focuses on determining the
extent to which state-level structural sexism and racism influences cognitive trajectories among sex/gender-by-
race groups. Aim 2 (R00) proposes to investigate whether sex/gender inequalities in cognitive reserve varies
across levels of structural sexism and racism exposure. This proposal leverages cognitive trajectory and AD-
biomarker data from five cohort and nationally representative longitudinal studies: Washington Heights-Inwood
Community Aging Project (WHICAP), Offspring study, Minority Aging Research Study (MARS), Health and
Retirement Study (HRS), and Reasons for Geographic and Racial Differences in Stroke (REGARDS). State-
level indicators of structural sexism and racism will be used. State-of-the-art statistical methods will be employed
to examine intersectionality that have been previously used in public health research, but that have not yet been
applied to longitudinal cognitive aging outcomes. This research plan is complemented by a training plan that
builds on the candidate’s background in cognitive aging, health disparities, and advanced statistical methods
and includes new training in (1) cutting-edge analytic intersectionality techniques, (2) measuring and modeling
structural determinants of health, (3) sex/gender differences in AD-biomarkers, and (4) causal inference
methods. The combined research and training plans will prepare the applicant for a successful independent
research career focused on identifying macro-social and biological determinants of sex/gender inequalities in
AD.

## Key facts

- **NIH application ID:** 10507032
- **Project number:** 1K99AG078440-01
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Justina Frances Avila-Rieger
- **Activity code:** K99 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $130,842
- **Award type:** 1
- **Project period:** 2022-09-01 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10507032

## Citation

> US National Institutes of Health, RePORTER application 10507032, Social Mechanisms Underlying Sex/Gender Inequalities in Alzheimers Disease: An Intersectionality Approach (1K99AG078440-01). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10507032. Licensed CC0.

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