Migrating the National Long Term Care Survey to the MedRIC Health and Aging Data Enclave

标题 将国家长期护理调查迁移到Medric Health and Aging Data飞地 摘要 随着美国65岁的预期寿命持续增加，仅慢性病和慢性病的组合 给美国老年人带来越来越沉重的负担，并继续成为导致残疾和 死亡率。阿尔茨海默病(AD)和相关痴呆(ADRD)已成为努力的重要焦点 减轻老年人的慢性病负担。这是有充分理由的，就像中风一样，这些 疾病是认知障碍以及与之相关的功能和生活质量丧失的主要原因。 然而，AD/ADRD只是不健康老龄化的一个方面，并与其他高影响不利因素协同工作 健康状况。这些情况中的许多都是导致非认知障碍的主要原因，而且有显著的 风险重叠，即一种慢性病增加了其他慢性病的发病风险。的一个重要方面 为老年慢性病/多发病相关的当前和未来负担做好准备 了解这些健康趋势是否伴随着总寿命天数的减少 慢性发病率/残疾--反映发病率/残疾发生率与病例-- 续存率--由病死率和病例恢复率产生。这称为发病率/死亡率。 压缩，这是本补编的父赠款的主要重点(R01AG063971：03/15/2020- 02/28/2025)，旨在测试三个互补目标的两个主要假设：[h1]可修改 非遗传风险因素解释了近期发病率、患病率和持续性的时间变化。 认知和身体损伤；以及[H2]体质遗传和表观遗传因素调节 终生发病率/残疾发生率、认知功能障碍的患病率和持续性的个体差异 身体上的损伤。为了实现这些目标，在单个位置联合访问多个与CMS关联的数据是 这是必要的；但监管改革使这一点变得具有挑战性。这些同样的监管变化也造成了 意想不到的机会：(1)向NIA提供全国长期护理调查(NLTCS) 医疗保险和医疗补助资源信息中心(MEDIC)健康和老龄化数据(HAAD)的研究人员 Enclave--NIA赞助的所有与CMS有关的研究的未来发源地--作为与CMS有关的新数据资源；以及 (2)使用Medric Haad Enclave对母基金中列出的CMS链接数据集进行联合分析， 从而加快了实现其目标的进度。通过增强的数据分析利用这两个机会 并对哈德飞地进行比较评估，是本补编的目的。它呈现了一种独特的 正式审查、评估和建议的机会，以提高MEDICE的效率 HAAD Enclave从NLTCS的用户和管理员的角度，与基于HAAD的比较 与杜克大学的另外两个基于云的解决方案相比，工作效率有所提高。所有改进 哈德飞地的效率将使NIH/NIA的研究人员受益，因为CMS数据的分布 通过Medric Haad飞地，预计未来将是这些数据的唯一分发方式。

TITLE Migrating the National Long-Term Care Survey to the MedRIC Health and Aging Data Enclave ABSTRACT As life expectancy at age 65 continues to increase in the U.S., chronic diseases alone and in combination are placing an increasingly heavy burden on U.S. older adults and continue to be leading causes of disability and mortality. Alzheimer’s disease (AD) and related dementias (ADRD) have become important focal points for efforts to reduce the burden of chronic diseases on older adults. This is with good cause, as together with stroke, these conditions are the leading causes of cognitive impairment and associated loss of function and quality of life. However, AD/ADRD is but one aspect of unhealthy aging and operates in concert with other high impact adverse health conditions. Many of these conditions are leading causes of non-cognitive disability, and there is significant overlap of risk where one chronic illness imposes increased risk for the onset of others. An important aspect of preparing for the current and future burdens associated with chronic morbidity/multimorbidity in older ages is acquiring an understanding of whether these health trends are accompanied by a reduction in total lifetime days of chronic morbidity/disability—reflecting a balance between morbidity/disability incidence rates and case- continuance rates—generated by case-fatality and case-recovery rates. This is termed morbidity/mortality compression and is the primary focus of this Supplement’s parent grant (R01AG063971: 03/15/2020– 02/28/2025) which seeks to test two major hypotheses across three complementary Aims: [H1] that modifiable non-genetic risk factors account for the recent temporal changes in the incidence, prevalence, and continuance of cognitive and physical impairments; and [H2] that constitutional genetic and epigenetic factors modulate individual differences in lifetime morbidity/disability incidence, prevalence, and continuance of cognitive and physical impairments. To achieve these Aims, joint access to multiple CMS-linked data in a single location is necessary; but regulatory changes have made this challenging. These same regulatory changes also created unexpected opportunities: (1) to make the National Long Term Care Survey (NLTCS) available to NIA researchers on the Medicare & Medicaid Resource Information Center (MedRIC) Health and Aging Data (HaAD) Enclave—the future home of all NIA-sponsored CMS-linked studies—as a new CMS-linked data resource; and (2) to use the MedRIC HaAD enclave for the joint analysis of the CMS-linked datasets listed in the parent grant, thereby accelerating the rate of progress on its Aims. Exploiting both opportunities, with enhanced data analysis and comparative assessment of the HaAD enclave, is the goal of this Supplement. It presents a unique opportunity for formal review, evaluation, and recommendations for enhancement of the efficiency of the MedRIC HaAD enclave from the point of view of users and administrators of the NLTCS, with comparison of HaAD-based productivity gains to those achieved with two other CLOUD-based solutions at Duke University. All improvements in the efficiency of the HaAD enclave will benefit NIH/NIA researchers because the distribution of CMS data through the MedRIC HaAD enclave is expected to be the sole mode of distribution of these data in the future.