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Racial Disparities in Delayed Dementia Diagnosis: Structural Determinants and Validation of Timeliness Measures

延迟性痴呆诊断中的种族差异：结构性决定因素和及时性措施的验证

基本信息

批准号：
10506316
负责人：
Min Hee Kim
金额：
$ 12.42万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10506316
关键词：
Aging Algorithms Alzheimer&apos s Disease Alzheimer&apos s disease care Alzheimer&apos s disease related dementia Area Atlases Attention Automobile Driving Black Populations Black race Caring Characteristics Clinical assessments Communities Complement Data Dementia Diagnosis Diagnostic Disease Education Elderly Ensure Epidemiologic Methods Epidemiology Examinations and Diagnoses Face Family Future Geography Goals Health Health Care Costs Health Care Sector Health Services Health Services Research Health and Retirement Study Healthcare Incidence Individual Infrastructure Intervention Knowledge Link Measures Medical Medicare Medicare claim Mentorship Natural History Neighborhoods Neurodegenerative Disorders Pathway interactions Patients Pattern Perception Persons Phase Policies Population Prevention Preventive care Primary Health Care Race Research Research Personnel Research Training Resources Risk Risk Factors Sampling Social Work Sociology Stroke Structural Racism Surveys Time Training Transportation Validation accurate diagnosis base career clinical diagnosis cohort density deprivation design disparity reduction geographic disparity health care availability health care service utilization improved innovation multidisciplinary public health intervention racial and ethnic disparities racial disparity racial health disparity residential segregation segregation social survival prediction temporal measurement time interval trend

项目摘要

PROJECT SUMMARY The number of people impacted by Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (ADRD) is 5 million in the US alone and is expected to grow, especially in Black communities. Black older adults have a 40-80% higher incidence of ADRD and approximately double the risk of underdiagnosis. Innovative use of survey-Medicare Claims linked data holds promise to advance our understanding of disparities in timely ADRD diagnosis and their contributing factors. However, no prior research has validated this approach. Also, prior research on risk factors for delayed ADRD diagnosis has focused on individual-level characteristics that are difficult to modify. I seek to fill this gap by validating the measure of timeliness of ADRD diagnosis with respect to the survival benefits and examining placed-based structural factors associated with disparities in timely ADRD diagnosis. Residential racial segregation and geographic features of health care access are important to consider together. While unequal distribution of health care resources in segregated areas may be the primary driver of the racial disparities in timely diagnosis, residential segregation may capture unobserved features of structural racism influencing health care utilization patterns by race. These factors can be mutually reinforcing drivers of poor diagnosis in the Black population. In the K99 phase, I will conduct a robust epidemiological analysis to examine the timeliness of ADRD diagnosis related to survival using the Health and Retirement Study and the National Health and Aging Trends Study. In the R00 phase, I will examine the association between residential racial segregation or health care access features and racial disparities in the timeliness of ADRD diagnosis while extending my inquiry to the cohort from the Reasons for Geographic and Racial Disparities in Stroke study. I will also examine how the magnitude of the association between health service characteristics and timely ADRD diagnosis differs by small-area characteristics (e.g., area deprivation) and individual characteristics (e.g., education). This research plan is complemented by a training plan that builds on my background in social work and sociology, and includes new training in (1) neurodegenerative diseases, clinical assessment, and diagnostic pathways; (2) application of algorithm-based dementia assessment in surveys; (3) utilization of Medicare claims data, and (4) gaining additional sociological knowledge in linking data in residential segregation, health care access, and racial disparities related to timely ADRD diagnosis. The combined research and training plans will prepare me for a successful independent research career focused on identifying modifiable determinants of Alzheimer’s disease and related dementias, and study of the effects of policies and interventions to reduce racial disparities in ADRD. Together, these have the potential to improve prevention and care in ADRD. My mentorship team is uniquely poised to assist me in achieving my training and research goals and ensure my successful transition to independent investigator status.

项目总结