Assessing Diagnosis and Treatment Delays and Health Care Disparities by Race/Ethnicity among Individuals with Alzheimer's Disease and Related Dementias

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Project Summary/Abstract Early detection and management of Alzheimer's Disease and Related Dementias (ADRD) is crucial to promoting patient outcomes, maximizing quality of life for both the patient and caregiver, and optimizing health care utilization. Evidence suggests that African Americans and Hispanics may experience ADRD diagnosis and treatment delays despite having a higher disease prevalence than whites. Better targeting of ADRD care improvement efforts across racial and ethnic groups depends on robust assessment of diagnosis and treatment delays, resulting health outcomes, and care utilization patterns in these populations. This application investigates racial and ethnic disparities in ADRD diagnosis and management, from the early to end-of-life stages of the disease. We will leverage survey data with unique measures of cognitive function from the Health and Retirement Survey (HRS) and the Aging, Demographics and Memory Study (ADAMS), linked with Medicare and Medicaid claims files. The HRS is a continuous, national survey of U.S. adults over age 50 representative of community-dwelling and nursing home residents. The HRS interviews ~20,000 respondents every two years, with oversampling of African Americans and Hispanics. Using this database, which links claims data to a population-based survey with unique cognitive functioning measures to assess ADRD severity, our study can address limitations of prior research to achieve the following aims: Aim 1: Characterize ADRD diagnosis delay by race/ethnicity, adjusting for disease severity Hypothesis 1.1: African Americans and Hispanics with early ADRD are less likely than whites to receive a coded diagnosis of ADRD on their Medicare or Medicaid claims Hypothesis 1.2: African Americans and Hispanics have more advanced ADRD at diagnosis than whites Aim 2: Characterize ADRD treatment delay and discontinuation by race/ethnicity, adjusting for disease severity Hypothesis 2.1: African Americans and Hispanics are less likely than whites to be treated with anti-dementia medications following initial diagnosis Hypothesis 2.2: African Americans and Hispanics are more likely than whites to discontinue anti-dementia medication therapy following initial diagnosis Aim 3: Characterize racial and ethnic disparities in ADRD health care costs and end-of-life care, adjusting for disease severity Hypothesis 3.1: African Americans and Hispanics with ADRD have more potentially avoidable hospitalizations, more unplanned 30-day readmissions, and higher health care costs than whites Hypothesis 3.2: African-Americans and Hispanics with ADRD have lower hospice use, more burdensome interventions at the end of life, and higher end-of-life costs than whites 1