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Health Inequalities Lab Projects

LIFELONG – Early Life Policies to Delay Biological Ageing over the Lifecourse (2023-2028, PI: Emilie Courtin)

Funder: European Research Council Starting grant (UKRI Pioneer guarantee)

Ageing is not a simple reflection of the number of years lived: individuals age at different rates. People from disadvantaged backgrounds tend to be exposed to social and environmental factors that accelerate the rate of biological ageing relative to chronological age, resulting in the premature onset of disease, disability and death. A major contributor to accelerated ageing is poverty-associated stress, which begins in the womb and extend throughout life. Ideally, social interventions would be provided early in life, before exposures accumulate. Establishing the impact of early life interventions on healthy ageing over the life course is challenging because longer-term follow-up is rarely available.

LIFELONG will seek to do just that using innovative measures of biological ageing which can capture changes in healthy ageing over timescales of years rather than decades, long before chronic diseases manifest themselves. Specifically, we will determine (1) whether an intensive early life intervention can delay biological ageing in adolescence; (2) whether education policies targeting duration, quality and access to schooling can impact the rate of biological ageing in adulthood; and (3) the effect of delaying biological ageing through early life social interventions on future mortality and morbidity trends.


 

The Project STAR Healthy Ageing Experiment (2023-2025, PI: Peter Muennig)

Funder: National Institute on Ageing

The purpose of the Project STAR Healthy Ageing Experiment is to obtain preliminary data to support a larger study that would recontact 11,240 participants of a successful multicenter randomized controlled trial of small class sizes called Project Student/Teacher Achievement Ratio (STAR). This future study would provide critically important information on whether changes to early childhood education can have positive impacts on healthy aging and risk factors for Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (AD/ADRD). The original study, conducted between 1985-1989, produced higher rates of high school graduation, college attendance, earnings, home ownership, higher savings, and lower crime among treated participants relative to control participants. Because these are social determinants of health, we expect that it also improved participants’ health and aging and proximate risk factors for AD/ADRD. Project STAR therefore presents one potential solution to the vexing problem of declining health in the United States. Project STAR is unique not only because it experimentally tests the value of small class size on education, but also because it tests other measures of classroom quality, such as teacher experience. It therefore allows for two experiments in one.

Our short-term objectives are to examine whether Project STAR reduced premature mortality for the treatment group relative to the control group and to assess the feasibility of recontacting the original cohort. Our long-term objective is to turn Project STAR into a living cohort to study the social determinants of healthy aging by collecting laboratory and survey data, including biological age, pace of aging and proximal risk factors for AD/ADRD. The aims of the study are: (1) to collect preliminary data for a future R01; (2) to determine whether small class sizes reduce premature mortality in mid-adulthood; and (3) to release a dataset linking Project STAR experimental data to prospective mortality records using NDI.



The contribution of adult child socio-economic status to parents' risk and outcomes of Alzheimer's disease and related dementias (ADRDs) in cross-national settings (2022-2027, PI: Jacqueline Torres)

Funder: National Institute on Ageing

Globally, nearly 10 million older adults are diagnosed with Alzheimer’s disease and related dementias (ADRDs) each year. Given the current absence of effective pharmacological treatments, along with global disparities in dementia care, there is an urgent need to identify population-level targets of ADRDs prevention and intervention, including at the family and societal level. Much of the population-level ADRDs research focuses on the contributions of one’s own socio-economic status (SES) to later life ADRDs risk. However, in many global settings, the SES of adult children may be a critical driver of parents’ economic, informational, and behavioral resources in late life. Nevertheless, very little research has evaluated the impact of adult child SES on parents’ ADRDs risk or outcomes of ADRDs. This is a surprisingly overlooked opportunity given prior literature suggesting that adult child educational attainment may influence parents’ physical and mental health and mortality outcomes, independent of parents’ own education.

The objective of this proposed study is to rigorously evaluate the potential for adult child SES to reduce parental ADRDs risk and improve outcomes among older parents with ADRDs in global settings. We propose to use population-level cohort data on over 156,000 adults representing 20 countries in North and Central America, Asia, and Europe, and with similar measures of adult child education and rich data on candidate mediators and multi-level modifiers. These global data will allow us to achieve excellent external validity not possible with single- country studies, and we will use rigorous observational approaches for analyses of main effects and mediation. To maximize internal validity, we will validate observational estimates with a quasi-experimental approach that leverages changes to compulsory schooling laws as “natural experiments” to identify the causal effect of increases to adult child education on parents’ longitudinal cognitive outcomes. The specific aims of the study are to (1) Quantify the influence of adult child SES on older parents’ cognitive decline, risk of probable dementia or cognitive impairment, and outcomes for older parents after dementia onset; (2) Evaluate economic and non-economic mediators of observed associations between adult child SES and parents’ ADRDs risk and outcomes, and (3) Identify within and cross-country heterogeneity in the association between adult child SES and parents’ ADRD risk and outcomes.


 

CELLO - Cellular metabolism over a life-course in socioeconomic disadvantaged populations (2022-2025, PI: Sian Henson)

Funder: Medical Research Council and Biotechnology and Biological Sciences Research Council

This networking grant proposes to bring an interdisciplinary team together to investigate how cellular metabolic dysfunction of the ageing cell is dictated by both intrinsic and extrinsic mechanisms from an early age. As intrinsic and extrinsic factors never work in isolation, we will bring together artificial intelligence (AI) experts and bioinformaticians to integrate intrinsic and extrinsic datasets with the aim of modelling the dysregulated metabolism within cells during the life-arc. Specifically, the network will probe the following: (1) Intrinsic factors (genetic and pathway-driven) that influence cellular metabolism over a life course; (2) Extrinsic factors (environmental, biopsychosocial and epigenetic) that influence cellular metabolism over a life course and (3) Integration of intrinsic and extrinsic factors to model cellular metabolism over a life course. The network comprises biologists, geneticists, clinicians, nutritionists, sports scientists, epidemiologists, geographers, AI and bioinformatic experts, economists, policy makers, urban planners and architects; who will work alongside stakeholders including The Dunhill Medical Trust, Dance4 and the North Thames diabetes lay panel. By removing academics from their silos it is hoped that we will find the collective insight and imagination to recognise, tackle and redress health inequalities to benefit our most disadvantaged communities though an understanding of the deregulation of cell metabolism. 


 

KEHC - Kid’s Environment and Health Cohort (2022-25, PI: Pia Hardelid)

Funder: Administrative Data Research UK

The aim of KEHC is to develop a large-scale data resource to explore the impact of the environment on child health, wellbeing and development. We will set up a new national data resource to examine how the physical and social environment influences children’s health and schooling across England. We will set up a national database containing de-identified data from schools, hospitals and community pharmacies on health and education histories for all children born in England from 2006 onwards – around 11 million children. These data will also be linked to information about their mothers’ health during pregnancy as well as data on local environments in and around children’s homes and schools.


 

GINCO – Gender and health inequalities in the Constances cohort: Social determinants of healthy ageing in women and men (2020-2025, PI: Emmanuelle Cambois)

Funder: French National Research Agency

The project focuses on the social determinants of gender differences in health, particularly at older ages, at the intersection of the professional, social and family spheres. Using data from the CONSTANCES cohort, it is based on a life-course approach to social determinants of health. Its aim is to suggest levers for action, particularly through public policies, to improve the chances of ageing in good health and reduce inequalities. Our team is leading a work package evaluating the health effects of family policies designed to enable women to take time off work to care for their children. 

 

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