Racial Disparities in Delayed Dementia Diagnosis: Structural Determinants and Validation of Timeliness Measures

延迟性痴呆诊断中的种族差异：结构性决定因素和及时性措施的验证

• 批准号: 10683283
• 负责人: Min Hee Kim
• 金额: $ 12.42万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10683283
• 关键词: Aging; Algorithms; Alzheimer' s Disease; Alzheimer' s disease care; Alzheimer' s disease related dementia; Area; Atlases; Attention; Automobile Driving; Black Populations; Black race; Caring; Characteristics; Classification; Clinical assessments; Communities; Complement; Data; Dementia; Diagnosis; Diagnostic; Disease; Disparity; Disparity in diagnosis; Education; Elderly; Ensure; Epidemiologic Methods; Epidemiology; Examinations and Diagnoses; Face; Family; Future; Geography; Goals; Health; Health Care Costs; Health Care Sector; Health Services; Health Services Research; Health and Retirement Study; Health care facility; Healthcare; Incidence; Individual; Infrastructure; Institution; Intervention; Knowledge; Link; Measurement; Measures; Medical; Medicare; Medicare claim; Mentorship; Natural History; Neighborhoods; Neurodegenerative Disorders; Pathway interactions; Patients; Pattern; Perception; Persons; Phase; Policies; Population; Prevention; Preventive care; Primary Care; Primary Health Care; Probability; Provider; Race; Racial Segregation; Research; Research Personnel; Resources; Risk; Risk Factors; Sampling; Social Work; Sociology; Stroke; Structural Racism; Surveys; Training; Transportation; Validation; access disparities; accurate diagnosis; career; clinical diagnosis; cohort; density; deprivation; design; disparity reduction; ethnic disparity; geographic disparity; health care availability; health care disparity; health care service utilization; improved; innovation; multidisciplinary; public health intervention; racial disparity; racial health disparity; residential segregation; segregation; social; social epidemiology; structural determinants; survival prediction; time interval; trend

PROJECT SUMMARY The number of people impacted by Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (ADRD) is 5 million in the US alone and is expected to grow, especially in Black communities. Black older adults have a 40-80% higher incidence of ADRD and approximately double the risk of underdiagnosis. Innovative use of survey-Medicare Claims linked data holds promise to advance our understanding of disparities in timely ADRD diagnosis and their contributing factors. However, no prior research has validated this approach. Also, prior research on risk factors for delayed ADRD diagnosis has focused on individual-level characteristics that are difficult to modify. I seek to fill this gap by validating the measure of timeliness of ADRD diagnosis with respect to the survival benefits and examining placed-based structural factors associated with disparities in timely ADRD diagnosis. Residential racial segregation and geographic features of health care access are important to consider together. While unequal distribution of health care resources in segregated areas may be the primary driver of the racial disparities in timely diagnosis, residential segregation may capture unobserved features of structural racism influencing health care utilization patterns by race. These factors can be mutually reinforcing drivers of poor diagnosis in the Black population. In the K99 phase, I will conduct a robust epidemiological analysis to examine the timeliness of ADRD diagnosis related to survival using the Health and Retirement Study and the National Health and Aging Trends Study. In the R00 phase, I will examine the association between residential racial segregation or health care access features and racial disparities in the timeliness of ADRD diagnosis while extending my inquiry to the cohort from the Reasons for Geographic and Racial Disparities in Stroke study. I will also examine how the magnitude of the association between health service characteristics and timely ADRD diagnosis differs by small-area characteristics (e.g., area deprivation) and individual characteristics (e.g., education). This research plan is complemented by a training plan that builds on my background in social work and sociology, and includes new training in (1) neurodegenerative diseases, clinical assessment, and diagnostic pathways; (2) application of algorithm-based dementia assessment in surveys; (3) utilization of Medicare claims data, and (4) gaining additional sociological knowledge in linking data in residential segregation, health care access, and racial disparities related to timely ADRD diagnosis. The combined research and training plans will prepare me for a successful independent research career focused on identifying modifiable determinants of Alzheimer’s disease and related dementias, and study of the effects of policies and interventions to reduce racial disparities in ADRD. Together, these have the potential to improve prevention and care in ADRD. My mentorship team is uniquely poised to assist me in achieving my training and research goals and ensure my successful transition to independent investigator status.

项目摘要 受阿尔茨海默病和阿尔茨海默病相关痴呆症（ADRD）影响的人数 仅在美国就有500万人，预计还会增长，特别是在黑人社区。黑人老年人有 ADRD的发病率高出40-80%，诊断不足的风险约为两倍。创新使用 调查-医疗保险索赔关联数据有望促进我们对ADRD及时性差异的理解 诊断及其影响因素。然而，没有先前的研究证实了这种方法。另外，Prior 关于延迟ADRD诊断的风险因素的研究集中在个体水平的特征上， 很难修改。我试图通过验证ADRD诊断的及时性来填补这一空白， 生存福利，并及时审查与差异有关的基于职位的结构性因素， ADRD诊断。居住的种族隔离和获得医疗保健的地理特征对 一起考虑。虽然隔离地区的卫生保健资源分配不平等可能是主要原因， 种族差异的驱动因素，及时诊断，居住隔离可能会捕捉到未观察到的特点， 按种族分列的影响保健利用模式的结构性种族主义。这些因素可以相辅相成 黑人中诊断不佳的驱动因素。在K99阶段，我将进行一次强有力的流行病学调查， 使用健康和退休分析来检查与生存相关的ADRD诊断的及时性 国家健康和老龄化趋势研究。在R 00阶段，我将检查关联 居住区种族隔离或医疗保健获得特征与种族差异之间的关系， ADRD诊断，同时将我的调查扩展到来自地理和种族原因的队列 中风研究中的差异。我还将研究卫生服务与医疗服务之间的关联程度， 特征和及时的ADRD诊断因小区域特征而不同（例如，地区剥夺）和 个体特征（例如，教育）。该研究计划由一个培训计划补充，该计划建立在 我在社会工作和社会学方面的背景，包括（1）神经退行性疾病， 临床评估和诊断途径;（2）基于算法的痴呆评估在 调查;（3）利用医疗保险索赔数据，（4）获得更多的社会学知识， 与ADRD及时诊断相关的居住隔离、医疗保健获得和种族差异数据。 结合研究和培训计划将准备我一个成功的独立研究生涯 专注于确定阿尔茨海默病和相关痴呆症的可变决定因素， 政策和干预措施的效果，以减少ADRD中的种族差异。总之，这些有可能 改善ADRD的预防和护理。我的导师团队是独一无二的，他们随时准备帮助我实现我的目标。 培训和研究目标，并确保我成功过渡到独立研究者的地位。