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

项目概要 各种疗养院 (NH) 服务和健康结果都存在种族/民族健康差异。这些 差异直接影响NHs中老年人接受的护理。阿尔茨海默病和相关痴呆症 (ADRD) 充当“差距乘数”，因为新罕布什尔州黑人和西班牙裔居民的健康状况较差 对于患有 ADRD 的居民来说，这些差异更为明显。交叉点和交叉点的重要性 COVID-19 大流行凸显了种族/族裔健康差异和 ADRD 的严重性， 对新罕布什尔州居民和 ADRD 患者的影响尤为严重。此次疫情还揭示了如何 值得注意的是，这些差异可能因地理位置而异。尽管 COVID-19 的结果存在差异 种族/族裔和地理位置，以及 ADRD 状况可能加剧这些差异，但证据很少 其存在是为了准确地揭示种族/族裔、地理和 ADRD 状态如何或在多大程度上交叉在一起 影响新罕布什尔州老年居民的健康结果。此外，估计广泛范围的最佳方法 不同规模和人口统计数据的种族/民族不同亚人群之间的健康差异 地理单位仍不清楚。因此，拟议研究的长期目标是开发一种 用于研究不同地理单位的种族/民族健康差异的因果推理框架。目标1 将确定最合适的分析方法来量化跨地理区域的种族/民族差异 通过进行模拟研究来比较几种现有的生物统计方法。目标2将利用 这些结果可量化不同种族/民族状况、ADRD 之间的 COVID-19 疫苗使用和结果的健康差异 通过使用首创的电子医疗记录数据库来了解状态和地理位置 医疗保险索赔数据来自大约 10,000 个美国 NH。这项研究将提供一些初步的经验 为政策制定者和其他利益相关者提供可用于改善 COVID-19 和健康公平性的证据 其他条件。它还将建立可广泛使用的独特方法，以准确、及时和 未来有关新罕布什尔州居民和其他人群之间差异的相关研究。这些拟议的研究将 由首席研究员在具有高级统计专业知识的合作者的支持下完成 方法、健康差异、传染病流行病学、老年病学和 ADRD。主要研究者是 由包括老年学中心在内的协作和跨学科研究环境支持 和布朗大学公共卫生学院的医疗保健研究。本培训活动详细介绍 应用程序的重点是提高定量计算技能并开发深入的上下文 了解种族/民族健康差异以及患有 ADRD 的老年人的护理；他们将准备 作为独立流行病学家和卫生服务研究员的首席研究员。

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.