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 受阿尔茨海默氏病和阿尔茨海默氏病有关的痴呆症（ADRD）影响的人数 仅在美国，就有500万，预计将增长，尤其是在黑人社区。黑人老年人有一个 ADRD的事件增加40-80％，大约是诊断不足的风险的两倍。创新的使用 链接数据的调查中的索赔有望提高我们对及时的差距的理解 诊断及其促成因素。但是，没有先前的研究验证了这种方法。另外，先验 延迟ADRD诊断的风险因素的研究集中在个人级别特征上 难以修改。我试图通过验证ADRD诊断的及时性来填补这一空白 及时研究与差异相关的基于放置的结构因素 ADRD诊断。住宅种族隔离和医疗保健访问的地理特征对于 一起考虑。虽然隔离地区的医疗资源不平等的分配可能是主要的 种族分布的驱动力及时诊断，居民的隔离可能会捕获未观察到的特征 结构性种族主义会影响种族的医疗保健利用模式。这些因素可以相互加强 黑人人口诊断不佳的驱动因素。在K99阶段，我将进行强大的流行病学 分析以检查使用健康和退休与生存有关的ADRD诊断的及时性 研究与国家健康与衰老趋势研究。在R00阶段，我将检查协会 居民的种族隔离或医疗保健访问特征与及时的种族差异 从地理和种族的原因将我的询问扩展到同类的同时，ADRD诊断 中风研究的差异。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诊断差异是小面积特征（例如，剥夺区域剥夺）和 个人特征（例如教育）。该研究计划是由一项培训计划完成的 我在社会工作和社会学方面的背景，包括（1）神经退行性疾病的新培训， 临床评估和诊断途径； （2）基于算法的痴呆评估的应用 调查； （3）利用Medicare索赔数据，以及（4）在联系时获得更多的社会学知识 与及时的ADRD诊断有关的住宅隔离，医疗保健访问和种族分布的数据。 合并的研究和培训计划将为我准备成功的独立研究职业 专注于识别可修改的阿尔茨海默氏病和相关痴呆症的决定者，并研究 减少ADRD种族分布的政策和干预措施的影响。在一起，这些有可能 改善ADRD的预防和护理。我的Mentalship团队被唯一中毒，可以帮助我实现我的 培训和研究目标，并确保我成功过渡到独立研究者的状态。