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

基本信息

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
项目类别：
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&apos s Disease Alzheimer&apos s disease care Alzheimer&apos 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

项目摘要

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.

项目概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，并且预计还会增长，尤其是在黑人社区。 ADRD 发病率增加 40-80%，诊断不足的风险大约增加一倍。调查-医疗保险索赔关联数据有望促进我们及时了解 ADRD 差异诊断及其影响因素。然而，之前没有研究验证过这种方法。对 ADRD 延迟诊断的危险因素的研究主要集中在个体层面的特征上，这些特征是：我试图通过验证 ADRD 诊断的及时性来填补这一空白。生存效益并及时检查与差异相关的基于位置的结构性因素 ADRD 诊断。居住种族隔离和医疗保健获取的地理特征对于诊断非常重要。共同考虑，而隔离地区医疗保健资源分配不均可能是主要问题。作为及时诊断中种族差异的驱动因素，居住隔离可能会捕捉到未观察到的特征结构性种族主义按种族影响医疗保健利用模式，这些因素可能是相辅相成的。在 K99 阶段，我将进行一项强有力的流行病学调查。使用健康和退休进行分析，检查与生存相关的 ADRD 诊断的及时性研究和国家健康与老龄化趋势研究在 R00 阶段，我将研究该关联。居住种族隔离或医疗保健获取特征与及时性方面的种族差异之间的关系 ADRD 诊断，同时将我的询问扩展到地理和种族原因的队列我还将研究中风研究中卫生服务之间关联的程度。特征和及时 ADRD 诊断因小区域特征（例如区域剥夺）和个人特征（例如教育）是该研究计划的补充。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， (2)基于算法的痴呆症评估的应用调查；(3) 利用医疗保险索赔数据，以及 (4) 获得链接方面的额外社会学知识与及时 ADRD 诊断相关的居住隔离、医疗保健获取和种族差异方面的数据。综合研究和培训计划将为我成功的独立研究生涯做好准备专注于识别阿尔茨海默氏病和相关痴呆症的可改变决定因素，并研究减少 ADRD 中种族差异的政策和干预措施的效果总而言之，有可能实现这一目标。改善 ADRD 的预防和护理我的导师团队非常愿意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身份。