Similarities and differences in Alzheimer's dementia comorbidities in racialized populations identified from electronic medical records.
Similarities and differences in Alzheimer's dementia comorbidities in racialized populations identified from electronic medical records.
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DOI：
10.1038/s43856-023-00280-2
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发表时间：
2023-04-08
期刊：
影响因子：
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通讯作者：
Sirota, Marina
中科院分区：
文献类型：
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作者：
Woldemariam, Sarah R;Tang, Alice S;Oskotsky, Tomiko T;Yaffe, Kristine;Sirota, Marina
阿尔茨海默氏痴呆症（AD）是一种神经退行性疾病，在种族边缘化的个体中不成比例地流行。然而，由于研究代表性不足，AD相关的合并症，增加AD风险或提示AD治疗差异，这些人的频谱并不完全了解。我们利用电子病历（EMR）在被确定为亚洲人、非拉丁裔黑人、拉丁裔或非拉丁裔白色人的种族化个体中探索AD相关的合并症和疾病网络。我们对两个EMR系统和五个医疗中心的5664例AD患者和11，328例人口统计学匹配的对照进行了低维嵌入，差异分析和基于疾病网络的分析，其中亚洲，非拉丁裔黑人，拉丁裔和非拉丁裔白人识别个体的代表性相同。对于低维嵌入和疾病网络比较，使用Mann-Whitney U检验或Kruskal-Wallis检验，然后使用Dunn检验来比较类别。使用Fisher精确检验或卡方检验进行差异分析。采用斯皮尔曼等级相关系数比较两种EMR系统的结果。在这里，我们表明，主要建立AD相关的合并症，如原发性高血压和重度抑郁症，一般是相似的种族人群。然而，少数合并症，包括呼吸系统疾病，可能与黑人和拉丁裔识别的个体中的AD显著相关。我们的研究揭示了种族化人群之间AD相关的合并症和疾病网络的相似性和差异。我们的方法可能是假设驱动的研究的起点，可以进一步探索这些合并症与种族化人群中的AD之间的关系，潜在地确定可以减少AD健康差异的干预措施。在美国，黑人和拉丁裔个体相对于亚裔和白色个体更可能患有阿尔茨海默氏痴呆症（AD）。尽管如此，黑人和拉丁裔识别的个体不太可能被纳入试图了解和治疗AD的研究中。由医疗保健提供者电子记录的患者医疗信息用于探索AD患者相对于未患有AD的患者是否更可能患有不同的疾病。我们分别对亚洲人、非拉丁裔黑人、拉丁裔和非拉丁裔白色人进行了分析，共进行了4次分析。虽然我们发现许多情况是所有人共有的，但有一些，如肺部相关疾病，可能在特定的种族和民族类别中更常见。Woldemariam等人使用电子病历来探索阿尔茨海默病患者的合并症，该患者按四个已确定的种族和民族类别分层。虽然大多数合并症相似，但少数合并症（包括呼吸系统疾病）与黑人和拉丁裔个体相关。
Alzheimer’s dementia (AD) is a neurodegenerative disease that is disproportionately prevalent in racially marginalized individuals. However, due to research underrepresentation, the spectrum of AD-associated comorbidities that increase AD risk or suggest AD treatment disparities in these individuals is not completely understood. We leveraged electronic medical records (EMR) to explore AD-associated comorbidities and disease networks in racialized individuals identified as Asian, Non-Latine Black, Latine, or Non-Latine White. We performed low-dimensional embedding, differential analysis, and disease network-based analyses of 5664 patients with AD and 11,328 demographically matched controls across two EMR systems and five medical centers, with equal representation of Asian-, Non-Latine Black-, Latine-, and Non-Latine White-identified individuals. For low-dimensional embedding and disease network comparisons, Mann-Whitney U tests or Kruskal-Wallis tests followed by Dunn’s tests were used to compare categories. Fisher’s exact or chi-squared tests were used for differential analysis. Spearman’s rank correlation coefficients were used to compare results between the two EMR systems. Here we show that primarily established AD-associated comorbidities, such as essential hypertension and major depressive disorder, are generally similar across racialized populations. However, a few comorbidities, including respiratory diseases, may be significantly associated with AD in Black- and Latine- identified individuals. Our study revealed similarities and differences in AD-associated comorbidities and disease networks between racialized populations. Our approach could be a starting point for hypothesis-driven studies that can further explore the relationship between these comorbidities and AD in racialized populations, potentially identifying interventions that can reduce AD health disparities. Black- and Latine- identified individuals in the United States are more likely to have Alzheimer’s dementia (AD) relative to Asian- and White- identified individuals. Despite this, Black- and Latine- identified individuals are less likely to be included in studies that attempt to understand and treat AD. Patients’ medical information, electronically recorded by healthcare providers, was used to explore whether patients with AD were more likely to have different conditions relative to patients who do not have AD. We did this analysis separately for Asian-, Non-Latine Black-, Latine- and Non-Latine White- identified individuals for a total of four analyses. While we found many conditions that were shared by all individuals, a few, such as lung-related diseases, may be more common in specific identified race and ethnicity categories. Woldemariam et al. use electronic medical records to explore comorbidities in individuals with Alzheimer’s Disease stratified by four identified race and ethnicity categories. Whilst most comorbidities are similar, a few comorbidities, including respiratory diseases, are associated with Black- and Latine- identified individuals.