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

项目总结 受阿尔茨海默病和阿尔茨海默病相关痴呆(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。黑人老年人有一种 ADRD的发病率增加了40%-80%，漏诊的风险大约增加了一倍。创新地使用 调查-与联邦医疗保险索赔相关的数据有望促进我们对及时ADRD差异的理解 诊断及其影响因素。然而，之前没有任何研究证实这一方法。此外，PIRE 延迟ADRD诊断的风险因素研究集中在个体水平的特征上，这些特征是 很难修改。我试图通过尊重地验证ADRD诊断的及时性来填补这一空白 生存利益和及时检查与差异相关的基于安置的结构性因素 ADRD诊断。居住的种族隔离和医疗保健服务的地理特征对 一起来考虑。虽然隔离地区的医疗资源分配不均可能是主要的 在及时诊断种族差异的驱动因素中，居住隔离可能会捕捉到未被观察到的特征 结构性种族主义影响按种族划分的卫生保健利用模式。这些因素可以相辅相成。 黑人人口中诊断不佳的司机。在K99阶段，我将进行一次强有力的流行病学 用《健康与退休》检验ADRD诊断生存的及时性分析 研究和国家健康和老龄化趋势研究。在R00阶段，我将检查关联 居住种族隔离或医疗保健获取特征与种族差异的及时性之间的关系 ADRD诊断，同时将我的询问从地理和种族原因扩展到队列 中风研究中的差异。我还将研究卫生服务之间的关联程度如何 特征和及时的ADRD诊断因小区域特征(例如，区域剥夺)和 个人特征(例如，教育)。这一研究计划得到了建立在以下基础上的培训计划的补充 我的社会工作和社会学背景，包括(1)神经退行性疾病的新培训， 临床评估和诊断途径；(2)基于算法的痴呆症评估在 调查；(3)医疗保险索赔数据的利用；(4)在链接中获得更多的社会学知识 与及时诊断ADRD有关的居住隔离、卫生保健获得情况和种族差异方面的数据。 合并的研究和培训计划将为我成功的独立研究生涯做好准备 重点是确定阿尔茨海默病和相关痴呆的可改变的决定因素，并研究 减少消除种族歧视的政策和干预措施的效果。加在一起，这些都有可能 改善ADRD的预防和护理。我的指导团队正准备帮助我实现我的 培训和研究目标，并确保我成功地过渡到独立调查员的身份。

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.