Racial and Geographic Disparities in Risk and Survival of Alzheimer's Disease and Related Dementias

阿尔茨海默病和相关痴呆症的风险和生存率存在种族和地理差异

• 批准号: 9891704
• 负责人: IGOR AKUSHEVICH
• 金额: $ 76.74万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9891704
• 关键词: Address; Adherence; Age; Algorithms; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Anesthesia procedures; Assessment tool; Behavior; Behavioral; Cause of Death; Code; Cognitive; Comorbidity; Data; Data Set; Databases; Death Certificates; Dementia; Development; Diagnosis; Disease; Elderly; Epidemiology; Ethnic Origin; Evaluation; Excision; Genetic; Geographic Locations; Geography; Goals; Habits; Health; Health Care Costs; Healthcare; Heterogeneity; Incidence; Income; Individual; Institute of Medicine (U.S.); Insurance Coverage; Joints; Literature; Longevity; Measures; Mediator of activation protein; Medical; Medicare; Methodology; Onset of illness; Outcome; Patient Care; Pattern; Pharmacological Treatment; Play; Population; Population Group; Population Heterogeneity; Prevalence; Preventive care; Primary Prevention; Procedures; Process; Public Health; Race; Research; Risk; Risk Estimate; Risk Factors; Role; Rural; Secondary Prevention; Series; Severities; Severity of illness; Subgroup; Telephone Interviews; Testing; Time; Time trend; base; cognitive function; cognitive interview; cognitive testing; dementia risk; design; health difference; health disparity; improved; insight; modifiable risk; mortality; nursing home length of stay; predictive modeling; public health intervention; racial discrimination; racial disparity; resilience; sex; socioeconomic disparity; socioeconomics; tertiary prevention; trend

Abstract There exists a limited number of studies that assess health disparities in Alzheimer’s Disease (AD) and even fewer for non-AD dementias. Insight from existing literature and our preliminary studies suggest that the most essential health disparities in Alzheimer’s disease (AD) and related dementias (ADRD) are related to race/ethnicity effects in AD risk and strong geographic gradient in mortality from AD. Our preliminary studies showed significant gaps between incidence rates for different race groups and mortality rates between East and West coast populations. In addition less significant disparities related to effects in rural/urban subpopulations and differences in survival from AD/ADRD were also identified. Detailed epidemiologic descriptions of these disparities, especially incorporating subgroups of AD-related dementias (ADRD), are lacking and the role of behavioral factors, comorbidity, time-dependent cognitive trajectories, and genetic effects in the developments of AD/ADRD are not sufficiently evaluated. Thus, there is a critical need to quantitatively describe the persistent disparities in the AD/ADRD outcomes and clarify the role of the multiple contributing factors. Our preliminary studies proved the ability to extract high-quality measures of the factors to be studied from the three datasets to be used in this study: 5%-Medicare, HRS-Medicare, and SEER-Medicare as well as Multiple Cause of Death database. Research in the project will be focused on i) re-evaluation of the disparities by calculating them with better accuracy and addressing limitations of our preliminary analyses, ii) multiple analyses designed to explain these disparities by analyzing the effects of potential mediators, iii) incorporating recent advanced methodological approaches such as a new partitioning approach for the decomposition of an overall trend into its causal components for analyses of these disparities in high volume data, and iv) incorporating new concepts for the explanation of these disparities, such as the contribution of over/underdiagnoses, heterogeneity in disease severity at time of diagnosis, analyses of patterns of conditions related to AD and ADRD, and the contribution of AD resilience to these disparities. Four Specific Aims planned in this study will deal with i) epidemiology of AD/ADRD, ii) behavior factors and comorbidity, iii) cognitive status and the effects of diagnosis severity and over/under diagnosis, and iv) genetic effects and cognitive resilience. The completion of these Aims will results not only in robust estimates of the disparities in AD/ADRD outcomes in diverse populations, but also, ultimately results in improvements in public health that can be achieved through reducing the identified disparities in AD/ADRD using targeted information based on the in-depth analyses conducted in this project. The expected outcome will be detailed disease-specific information presented in a quantitative form that provides the contribution of each studied factor to race/income-related health disparities in U.S. older adults. We will uncover the barriers in health-care provision that can be further used for improving primary, secondary, and tertiary prevention in the U.S. resulting, in their turn, in improved survival and higher life span.

抽象的 评估阿尔茨海默病 (AD) 甚至老年痴呆症的健康差异的研究数量有限 非 AD 痴呆症患者较少。现有文献和我们的初步研究表明，最 阿尔茨海默病 (AD) 和相关痴呆 (ADRD) 的基本健康差异与 种族/族裔对 AD 风险的影响以及 AD 死亡率的强烈地理梯度。我们的初步研究 显示不同种族群体的发病率和东部和东部之间的死亡率之间存在显着差异 西海岸人口。此外，与农村/城市亚人群的影响相关的差异不太显着 还确定了 AD/ADRD 生存率的差异。这些的详细流行病学描述 缺乏差异，特别是纳入 AD 相关痴呆 (ADRD) 亚组，并且 行为因素、合并症、时间依赖性认知轨迹以及发展中的遗传效应 AD/ADRD 的评估尚未充分。因此，迫切需要定量描述持久性 AD/ADRD 结果的差异，并阐明多种影响因素的作用。我们的初步 研究证明能够从三个数据集中提取要研究的因素的高质量测量值 本研究中使用：5%-Medicare、HRS-Medicare、SEER-Medicare 以及多种死因 数据库。该项目的研究将集中在 i) 通过计算差异来重新评估 更好的准确性并解决我们初步分析的局限性，ii）旨在解释的多重分析 通过分析潜在调解因素的影响来消除这些差异，iii) 结合最新的先进技术 方法论方法，例如将总体趋势分解为新的划分方法 分析大量数据中这些差异的因果成分，以及 iv) 纳入新概念 解释这些差异，例如过度诊断/诊断不足的贡献，异质性 诊断时的疾病严重程度、与 AD 和 ADRD 相关的病症模式分析以及 AD 复原力对这些差异的贡献。本研究计划的四个具体目标将涉及 i) AD/ADRD 的流行病学，ii) 行为因素和合并症，iii) 认知状态和诊断的影响 严重程度和过度/不足诊断，以及 iv) 遗传效应和认知弹性。这些目标的完成 不仅可以对不同人群中 AD/ADRD 结果的差异进行稳健估计，而且， 最终改善公共卫生，这可以通过减少已发现的差异来实现 在 AD/ADRD 中使用基于本项目进行的深入分析的有针对性的信息。预期的 结果将以定量形式呈现详细的疾病特定信息，提供 每个研究因素对美国老年人种族/收入相关健康差异的贡献。我们将揭开 医疗保健提供方面的障碍可进一步用于改善小学、中学和大学 美国的预防措施反过来又提高了生存率并延长了寿命。