Disparity in Incidence and Health Outcomes between Rural and Urban Patients with Alzheimers disease and related disorders

城乡阿尔茨海默病及相关疾病患者的发病率和健康结果差异

• 批准号: 9225408
• 负责人: Md Momotazur Rahman
• 金额: $ 8.13万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-05-01 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9225408
• 关键词: Acute; Affect; Age; Alzheimer' s Disease; Caring; Cessation of life; Communities; Data; Decision Making; Development; Diagnosis; Diagnostic; Disease; Education and Outreach; Elderly; Enrollment; Ensure; Ethnic Origin; Evidence based practice; Family; Family member; Fee-for-Service Plans; Future; Gender; Goals; Health; Health Personnel; Health Services; Health Services Accessibility; Health system; Healthcare; Home Care Services; Hospitalization; Improve Access; Incidence; Intervention; Knowledge; Life Expectancy; Link; Measures; Medicare; Medicare claim; Methods; Nursing Homes; Older Population; Outcome; Patients; Physicians; Policies; Policy Developments; Policy Maker; Population; Population Study; Prevalence; Prospective cohort study; Provider; Race; Research; Risk Factors; Rural; Rural Community; Rural Health; Rural Population; Scientist; Services; Surveys; System; Time; Visiting Nurse; Work; accurate diagnosis; adverse outcome; base; beneficiary; burden of illness; care delivery; clinical practice; design; evidence base; experience; health care quality; health care service utilization; health disparity; healthcare acceptability; human old age (65+); improved; insight; medical specialties; meetings; mortality; residence; rural area; rural setting; screening; urban area; urban disparity

ABSTRACT By 2030, over 20% of the US population will be at least 65 years old, the age at which incidence of Alzheimer's disease and related disorders (ADRD) begins to increase. In 2014, 17% of the population living in rural areas was already over the age of 65, suggesting that rural populations may be disproportionally affected by ADRD in current and coming years. There is growing evidence that disparities in disease burden as well as availability, accessibility, affordability, and acceptability of health services exist among older adults living in rural areas, likely contributing to the growing gap in life expectancy witnessed between urban and rural communities. Previous studies have found that ADRD prevalence rates vary by gender, race, and ethnicity, yet few studies have examined disparities in diagnosis and outcomes of older adults living in urban and rural areas. Studies that have examined rural health disparities related to ADRD have largely focused on issues related to access to care, and suggest that ADRD patients in rural areas are more likely to receive suboptimal healthcare. There is a gap in our knowledge on how place of residence influences diagnosis and subsequent outcomes of older adults with ADRD. Understanding if disparities exist for older adults with ADRD living in rural areas could yield important insights into the risk factors for ADRD, the variables influencing the experience of living with ADRD, and the methods by which they can be more effectively managed. The objective of this application, the first step toward this long-term goal, is to conduct a population based study and thorough analysis to identify if rural-urban disparities in the diagnostic incidence and prevalence of ADRD, healthcare utilization, and health outcomes exist. The central hypothesis of this proposal is that rural Medicare beneficiaries with ADRD will be diagnosed later in the course of their disease and experience worse health outcomes. This hypothesis is based on preliminary work that shows the prevalence rate of ADRD is lower, yet the mortality rate due to ADRD is higher in states with a higher share of its population living in rural areas. To achieve this objective, we propose two aims. First, we will compare the diagnostic incidence and prevalence of ADRD between Medicare beneficiaries living in rural and urban communities. Second, we will compare survival and trajectories of acute, nursing home and home health care use in six years following the initial diagnosis of ADRD between rural and urban beneficiaries. We propose to study fee-for-service Medicare beneficiaries in 2008-2015 integrating Medicare enrollment, claims, and resident assessment data. Findings of this study have several expected benefits for many. For policy makers, this research will enable evidence-based policy development aimed at improving rural health care. For rural health providers, this work will drive efforts to improve ADRD screening in order to ensure rural beneficiaries receive a timely diagnosis, which may delay future adverse outcomes. For rural health systems, these findings will help plan for future demand and understand gaps in our current system in meeting this population's needs.

抽象的 到 2030 年，超过 20% 的美国人口将至少 65 岁，即该年龄 阿尔茨海默病及相关疾病 (ADRD) 开始增加。 2014年，17%的人口居住在 农村地区的老年人已经超过 65 岁，这表明农村人口可能受到不成比例的影响 ADRD 在当前和未来几年。越来越多的证据表明，疾病负担和疾病负担方面存在差异 居住在以下地区的老年人对医疗服务的可获得性、可及性、可负担性和可接受性 农村地区，可能导致城乡之间预期寿命差距不断扩大 社区。先前的研究发现 ADRD 患病率因性别、种族和民族而异，但 很少有研究考察城市和农村老年人的诊断和结果差异 地区。研究与 ADRD 相关的农村健康差异的研究主要集中在问题上 与获得护理的机会有关，并表明农村地区的 ADRD 患者更有可能接受次优的治疗 卫生保健。我们对居住地如何影响诊断和后续治疗的认识存在差距 患有 ADRD 的老年人的结果。了解生活在农村的患有 ADRD 的老年人是否存在差异 这些领域可以对 ADRD 的风险因素、影响 ADRD 经历的变量产生重要的见解。 患有ADRD，以及更有效地管理它们的方法。此举的目的 应用程序是实现这一长期目标的第一步，是进行基于人群的研究并进行彻底的研究 分析以确定 ADRD、医疗保健的诊断发生率和患病率是否存在城乡差异 利用率和健康结果是存在的。该提案的中心假设是农村医疗保险 患有 ADRD 的受益人将在病程后期被诊断出来，并且健康状况会更差 结果。该假设基于初步研究，该研究表明 ADRD 的患病率较低，但 在农村地区人口比例较高的州，ADRD 导致的死亡率较高。到 为了实现这一目标，我们提出两个目标。首先，我们将比较诊断发生率和患病率 居住在农村和城市社区的医疗保险受益人之间的 ADRD。其次，我们将比较生存率 初步诊断后六年内急性病、疗养院和家庭医疗保健的使用轨迹 农村和城市受益人之间的 ADRD。我们建议研究按服务收费的医疗保险受益人 整合 2008-2015 年医疗保险登记、索赔和居民评估数据。这项研究的结果有 对许多人来说有几个预期的好处。对于政策制定者来说，这项研究将使基于证据的政策成为可能 发展目标是改善农村医疗保健。对于农村卫生服务提供者来说，这项工作将推动努力 改善 ADRD 筛查，以确保农村受益人及时得到诊断，这可能会延误 未来的不良后果。对于农村卫生系统来说，这些发现将有助于规划未来的需求和 了解我们当前系统在满足这一人群需求方面的差距。