Addressing racial/ethnic geographic disparities in COVID-19 health services and outcomes among nursing home residents with ADRD

项目总结 在各种疗养院服务和健康结果方面存在种族/民族健康差异。这些 差异直接影响到国民健康保险制度中老年人所得到的护理。阿尔茨海默病与相关痴呆 (ADRD)是一个“差距倍增器”，因为黑人和西班牙裔NH居民的健康状况更差 对于患有ADRD的居民来说，这些差异更加明显。交叉路口的重要性和 新冠肺炎大流行突显了种族/民族健康差距和ADRD的严重性， 对NH居民和患有ADRD的人造成了不成比例的影响。这次大流行也揭示了 值得注意的是，这些差异可能会因地理位置而异。尽管各国在新冠肺炎成果上存在差异 种族/族裔和地理位置，以及ADRD地位可能加剧这些差距，几乎没有证据 存在的目的是准确地揭示种族/民族、地理位置和ADRD地位如何或在多大程度上相互交叉，以共同 影响NH老年居民的健康结果。此外，估计宽范围的最优方法 不同规模和人口统计的种族/民族不同亚群之间的健康差距 地理单位仍不清楚。因此，拟议研究的长期目标是开发一种 因果推断框架，用于研究不同地理单位的种族/民族健康差异。目标1 将确定最合适的分析方法来量化不同地域的种族/民族差异 通过进行一项模拟研究，比较了几种现有的生物统计学方法。AIM 2将利用 这些结果根据种族/民族状况量化新冠肺炎疫苗使用和结果的健康差异 通过使用第一个电子病历数据库链接到以下位置，以了解状况和地域 联邦医疗保险索赔数据来自大约10,000名美国国民健康保险制度。这项研究将提供一些第一批经验性的 为政策制定者和其他利益攸关方提供的证据，可用于改善新冠肺炎和 其他条件。它还将建立可广泛使用的独特方法，以进行准确、及时和 关于NH居民和其他人口之间差异的相关未来研究。这些拟议的研究将是 由首席研究人员完成，并得到在高级统计方面具有深厚专业知识的合作者的支持 方法、健康差距、传染病流行病学、老年病学和ADRD。首席调查员是 由包括老年学中心在内的协作和跨学科研究环境提供支持 和布朗大学公共卫生学院的医疗保健研究。本文件中详细说明的培训活动 应用程序的重点是提高量化计算技能并开发更深层次的上下文 了解种族/民族健康差距和护理患有ADRD的老年人；他们将准备 作为独立流行病学家和卫生服务研究员的职业生涯的首席调查员。

PROJECT SUMMARY Racial/ethnic health disparities exist for a wide array of nursing home (NH) services and health outcomes. These disparities directly impact the care received by older adults in NHs. Alzheimer's Disease and Related Dementias (ADRD) serve as a “disparity multiplier,” in that Black and Hispanic NH residents have worse health outcomes and these differences are more pronounced for residents with ADRD. The importance of the intersection and severity of racial/ethnic health disparities and ADRD has been highlighted by the COVID-19 pandemic, which has disproportionately impacted NH residents and those with ADRD. The pandemic has also revealed how significantly these disparities may vary by geography. Despite the differences in COVID-19 outcomes by race/ethnicity and geography, and the potential exacerbation of these disparities by ADRD status, little evidence exists to reveal exactly how or to what extent race/ethnicity, geography, and ADRD status intersect to jointly impact the health outcomes of older NH residents. Additionally, the optimal methods for estimating wide-ranging health disparities between racially/ethnically diverse subpopulations of varying sizes and demographics across geographic units remain unclear. The long-term objective of the proposed research is therefore to develop a causal inference framework for studying racial/ethnic health disparities across different geographic units. Aim 1 will identify the most appropriate analytic approaches for quantifying racial/ethnic disparities across geographic units by conducting a simulation study comparing several existing biostatistical methods. Aim 2 will leverage these results to quantify health disparities in COVID-19 vaccine use and outcomes by racial/ethnic status, ADRD status, and geography through the use of a first-of-its-kind database of electronic medical records linked to Medicare claims data from approximately 10,000 US NHs. This research will provide some of the first empirical evidence for policymakers and other stakeholders that can be used to improve health equity for COVID-19 and other conditions. It will also establish unique methods that can be used broadly to conduct accurate, timely, and relevant future studies of disparities among NH residents and other populations. These proposed studies will be completed by the principal investigator with support from collaborators with deep expertise in advanced statistical methods, health disparities, infectious disease epidemiology, geriatrics, and ADRD. The principal investigator is supported by a collaborative and interdisciplinary research environment that includes the Center for Gerontology and Health Care Research at the Brown University School of Public Health. The training activities detailed in this application are focused on advancing quantitative computational skills and developing a deep contextual knowledge of racial/ethnic health disparities and the care of older adults with ADRD; they will prepare the principal investigator for a career as an independent epidemiologist and health services researcher.