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

摘要 存在有限数量的研究来评估阿尔茨海默病（AD）的健康差异， 而非AD痴呆患者的发病率更低。现有文献和我们的初步研究表明， 阿尔茨海默病（AD）和相关痴呆（ADRD）的基本健康差异与以下因素有关： AD风险的种族/民族效应和AD死亡率的强烈地理梯度。我们的初步研究 显示了不同种族群体的发病率和东部和南部之间的死亡率之间的显着差距。 西海岸的人口。此外，在农村/城市亚人口中， 并且还确定了AD/ADRD的存活率差异。详细的流行病学描述这些 缺乏差异，特别是纳入AD相关痴呆（ADRD）的亚组， 行为因素，共病，时间依赖性认知轨迹，以及发展中的遗传效应 对AD/ADRD的评价不充分。因此，迫切需要定量地描述持续的 AD/ADRD结果的差异，并澄清多种促成因素的作用。我们的初步 研究证明，有能力从三个数据集中提取高质量的因素进行研究， 本研究中使用：5%-Medicare、HRS-Medicare和SEER-Medicare以及多种死因 数据库该项目的研究将集中在i）通过计算它们来重新评估差异， 更好的准确性和解决我们初步分析的局限性，ii）旨在解释 这些差异通过分析潜在的调解人的影响，三）结合最近的先进的 方法学方法，例如将总体趋势分解为 分析大量数据中这些差异的因果成分，以及iv）纳入新概念 对于这些差异的解释，例如过度/诊断不足的贡献， 诊断时的疾病严重程度，与AD和ADRD相关的疾病模式分析，以及 AD弹性对这些差异的贡献。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 严重性和过度/诊断不足，以及iv）遗传效应和认知弹性。实现这些目标 将不仅导致对不同人群中AD/ADRD结局差异的可靠估计，而且， 通过缩小已确定的差距，最终改善公共卫生 利用基于本项目进行的深入分析的有针对性的信息，预期 结果将是以定量形式提供的详细疾病特异性信息， 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 卫生保健提供方面的障碍，可进一步用于改善初级、二级和三级卫生保健 在美国，预防导致，反过来，在改善生存和更长的寿命。

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.