NIA AD/ADRD Health Care Systems Research Collaboratory

摘要 SARS-CoV-2大流行对美国人口产生了毁灭性的影响，超过2500万人呈阳性 截至2021年2月初，有超过45万人死亡。在任何人群中，这种病毒的影响都不是 比老年人更明显，那些有明显共病的人，特别是与 痴呆症。所有基于人口的分析都发现，死亡风险随着年龄的增长呈对数增加。的确， 即使在疗养院虚弱的人群中，高龄对新冠肺炎的死亡率也有很大的影响。 此外，阿尔茨海默病和相关痴呆症(ADRD)的诊断似乎赋予了过量 无论是在养老院还是在疗养院，都有发病和死亡的风险。 幸运的是，现在有几种疫苗被批准用于成人人群。这些不仅是高度的 有效，但看起来很安全。布朗调查人员，在NIA资助的ADRD Impact的补充下 合作[3U54AG063546-02S5]，没有发现短期死亡率增加，也没有定义疾控中心 在接种疫苗的养老院居民中发生重大不良事件。虽然疫苗供应继续保持在 在当地有限制的，美国主要药店如CVS和Walgreens一直在从事疫苗接种 从2月的第二周开始，他们在全国各地的门店里有数百万名顾客。 尽管从一群接种疫苗的疗养院居民中获得了积极的数据，但监测罕见的不利因素 活动需要非常大的人口，这就是沃尔格林顾客的补充样本 表示在[3U54AG063546-02S7]奖下正在研究的CVS Medicare人群中增加。这个 对更多人口的需求尤其重要，因为那些患有ADRD的人已经患有 神经退行性疾病疫苗发生严重神经系统不良事件的风险可能更大。在……里面 此外，未知的潜在不良事件可能会导致疫苗接种不完全的比率很高(两针都是) 在老年人中。这种不确定性导致疫苗的犹豫不决，并可能导致在 种族/民族人群接种SARS-CoV-2疫苗，季节性流感疫苗接种存在差异 已经存在了。由于对疫苗的依赖，不完全接种疫苗在ADRD患者中可能更常见 负责运输的护理员。由于社会迫不及待地想给这些人接种有效的疫苗，我们 必须建立大规模人群主动的疫苗接种后监测系统，报告疫苗安全性。这 建议将Walgreens药房数据添加到现有工作中，以将Pharmacy客户记录与 联邦医疗保险声称将创建每周更新的数据基础设施，以确定哪些人接种了疫苗， 监测接种疫苗的不良反应，检查新冠病毒感染的“突破性”感染率。添加 来自Walgreen的132311.75亿联邦医疗保险受益药房客户的数据使我们能够跟踪 接种疫苗对近一半的医疗保险受益人人口产生的直接和长期影响。

ABSTRACT The SARS-CoV-2 pandemic has had a devastating impact on the US population with over 25 million positive cases and over 450,000 deaths as of early February, 2021. In no population has the impact of this virus been more apparent than in the elderly, those with significant co-morbidities and particularly the elderly living with dementia. All population-based analyses find that the risk of mortality increases logarithmically with age. Indeed, even in the frail nursing home population, advanced age has a substantial influence on COVID mortality. Furthermore, a diagnosis of Alzheimer’s Disease and Related Dementias (ADRD) appears to confer an excess risk of morbidity and mortality, whether in a nursing home or not. Fortunately, there are now several vaccines approved for use in adult populations. These not only are highly effective but appear safe. Brown investigators, under a supplement to the NIA funded ADRD IMPACT Collaboratory [3U54AG063546-02S5], have found no increase in short term mortality and no CDC defined significant adverse events among vaccinated nursing home residents. While vaccine supply continues to be locally restricted, major US pharmacies like CVS and Walgreens have been engaged in the vaccination of millions of their customers at their stores around the country beginning the second week of February. In spite of positive data from a population of vaccinated nursing home residents, monitoring rare adverse events requires very large populations which is what this supplemental sample of Walgreens customers represents adding to the CVS Medicare population being studied under the [3U54AG063546-02S7] award. The need for a larger population is particularly important because those with ADRD already suffering from neurodegenerative diseases may be at greater risk of serious neurological adverse events of vaccines. In addition, the unknown potential for adverse events may result in high rates of incomplete vaccination (both shots) among older adults. Such uncertainty contributes to vaccine hesitancy and may result in large disparities in SARS-CoV-2 vaccination among racial/ethnic groups, for which disparities in seasonal influenza vaccination already exist. Incomplete vaccination may be more common among those with ADRD due to dependence on a caregiver for transportation. Since society cannot wait to vaccinate this population with an effective vaccine, we must establish an active post-vaccination surveillance system of a large population to report vaccine safety. This proposal to add Walgreens Pharmacies data to the existing effort to match Pharmacy customer records with Medicare claims to create a data infrastructure that is updated weekly will characterize who is vaccinated, monitor adverse reactions to vaccination and examine the rate of “break through” infection with COVID. Adding data from Walgreen’s 13,231,175 million Medicare beneficiary pharmacy customers allows us to track the immediate and long term effects of vaccination on nearly half the population of Medicare beneficiaries.