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

摘要 目前评估阿尔茨海默病(AD)健康差异的研究数量有限，甚至 非AD痴呆症患者较少。从现有文献和我们的初步研究来看，大多数 阿尔茨海默病(AD)和相关痴呆(ADRD)的基本健康差异与 种族/民族对阿尔茨海默病风险的影响以及阿尔茨海默病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死亡率在东部和 西海岸人口。此外，与农村/城市人口影响有关的不太明显的差异 AD/ADRD患者的存活率也存在差异。这些疾病的详细流行病学描述 缺乏差异，特别是纳入阿尔茨海默病相关痴呆(ADRD)亚组，以及 发育中的行为因素、共病、依赖时间的认知轨迹和遗传效应 对AD/ADRD的评估不足。因此，迫切需要定量地描述持久的 (D)进一步了解AD/ADRD结果之间的差异，并澄清多种促成因素的作用。我们的预赛 研究证明，从三个数据集中提取要研究的因素的高质量度量的能力 在本研究中使用：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：1)通过计算差距来重新评估差距 提高我们初步分析的准确性和解决局限性，II)旨在解释的多重分析 通过分析潜在调解人的影响，这些差异，三)结合了最近的先进 方法论方法，如用于将总体趋势分解为 其因果部分，用于分析大量数据中的差异，以及四)纳入新概念 对于这些差异的解释，例如过度/低估诊断的贡献， 诊断时的疾病严重程度，与AD和ADRD相关的情况模式分析，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)行为因素和共病，III)认知状况和诊断的影响 严重程度和过度/低估诊断，以及iv)遗传效应和认知韧性。这些目标的实现 这不仅将导致对不同人群中AD/ADRD结果差异的有力估计，而且， 最终导致公共卫生的改善，这可以通过减少已确定的差距来实现 在AD/ADRD中，根据本项目进行的深入分析，使用有针对性的信息。预期中的 结果将是以量化形式提供的具体疾病的详细信息，以提供 每个研究因素对美国老年人种族/收入相关健康差距的贡献。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 美国的预防措施反过来又提高了他们的存活率和寿命。

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.