Social determinants of racial and ethnic disparities in ADRD diagnostic pathways

项目摘要/摘要 美国老龄化人口正在迅速变得更加种族和民族多样化，并持续解决 阿尔茨海默病和相关痴呆(ADRD)的诊断和护理差异是一项迫切的研究 优先考虑。从根本上说，这些差距的原因仍然严重缺乏研究，其机制 根本的种族和民族医疗保健不平等是不存在的。这个项目的主要目标是阐明 健康的社会决定因素在ADRD诊断和护理中的种族和民族差异中的作用 参加联邦医疗保险当前受益人调查的具有全国代表性的医疗保险受益人队列 (MCBS)链接到管理索赔数据。这项研究的首要假设是，社会因素将 在很大程度上调解种族和族裔与ADRD诊断和获得护理之间的关系 结果。在目标1中，我们将确定与ADRD诊断的及时性相关的关键社会决定因素， ADRD诊断的病因特异性，以及获得ADRD诊断护理的机会(专科评估和 推荐的诊断服务)。在目标2中，我们将实证检验健康的关键社会决定因素的作用 作为诊断和获得护理结果方面的种族和族裔差异的调解人。调查结果将提供 对现有健康差距框架的关键贡献，如果我们的假设得到支持，将有 通过确定需要干预和干预的最脆弱人群对临床护理的直接影响 促进建立诊断管道，以指导从业者和保健系统旨在 减少ADRD中的健康不平等现象。

PROJECT SUMMARY / ABSTRACT The U.S. aging population is rapidly becoming more racially and ethnically diverse and addressing persistent disparities in Alzheimer's disease and related dementias (ADRD) diagnosis and care is an urgent research priority. Fundamentally, the causes of these disparities remain gravely understudied and the mechanisms underlying racial and ethnic healthcare inequities are lacking. The primary goal of this project is to elucidate the role of social determinants of health in racial and ethnic disparities in ADRD diagnosis and care using data from a nationally representative cohort of Medicare beneficiaries enrolled in the Medicare Current Beneficiary Survey (MCBS) linked to administrative claims data. The overarching hypothesis of this study is that social factors will substantially mediate the relationship between race and ethnicity and ADRD diagnostic and access to care outcomes. In Aim 1, we will identify key social determinants associated with the timeliness of ADRD diagnosis, etiological specificity of ADRD diagnosis, and access to ADRD diagnostic care (specialty evaluation and recommended diagnostic services). In Aim 2, we will empirically test the role of key social determinants of health as mediators of racial and ethnic disparities in diagnostic and access to care outcomes. The findings will provide critical contributions to existing health disparities frameworks and, if our hypotheses are supported, will have direct implications for clinical care by identifying most vulnerable populations in need for interventions and facilitating the establishment of diagnostic pipelines to guide practitioners and healthcare systems aimed at reducing health inequities in ADRD.