The REWARD study asks whether and how exposure to cumulative contextual (dis)advantage shapes health inequities via epigenetic mechanisms. REWARD draws on data from the Survey of the Health of Wisconsin (SHOW), a uniquely rich dataset that combines social and health survey measures with residential histories spanning up to five decades, spatio-temporally linked neighborhood conditions, and epigenetic clocks constructed based on DNA methylation in whole blood. We develop and compare approaches to assessing cumulative (dis)advantage exposure and examine patterns of exposure across cohorts, racial groups, and geographic locations in Wisconsin, a state that encompasses both racially segregated urban centers and rural regions with primarily white and rapidly aging populations. We then consider the associations between cumulative exposures to contextual (dis)advantage and epigenetic markers of accelerated biological aging. We find that relative to models using single-point-in-time exposure metrics, models incorporating cumulative measures show a stronger association between exposure to neighborhood disadvantage and accelerated aging.
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