Disparities in Access to Critical Imaging Technologies for ADRD Diagnosis and Treatment
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PROJECT SUMMARY/ABSTRACT Recent FDA approval of lecanemab and the potential approval of donanemab offer promise for halting disease progression among the growing US population of individuals with Alzheimer’s disease (AD). However, many individuals with AD may not gain access to them because treatment depends crucially on access to diagnostic PET and MRI imaging technologies, which are expensive and unevenly distributed across the US, and on access to specialist physicians trained to appropriately refer patients with Alzheimer’s disease and related dementias (ADRD) to these technologies. Little is known about the racial/ethnic inequities and rural-urban disparities in access to imaging technologies and to the specialist gatekeepers of these technologies. Our team's long-term goal is to improve access to new therapies and technologies by analyzing institutional, market, and regulatory barriers to access, and characterizing the cost, utilization, morbidity, and mortality consequences of impeded access. The objective in this application is to characterize the US geographic distribution of PET and MRI facilities and of ADRD specialists, and to quantify racial/ethnic and rural-urban disparities in technology and specialist access. We will pursue three specific aims: (1) describe the geographic distribution of PET and MRI neuroimaging facilities and the characteristics of ADRD specialists who refer to these facilities; (2) quantify racial/ethnic and rural-urban disparities in access to these technologies and to ADRD specialists; (3) estimate the impact of access to imaging facilities and ADRD specialists on the utilization of PET and MRI neuroimaging services by race/ethnicity and urbanicity. The proposed research is innovative because it sheds light on an understudied but important barrier to equitable access to AD care – limited access to critical imaging technologies – and develops condition-specific linkages between technology data and data on providers and populations that can serve as a model for data development and further study of technological health care disparities more generally. The proposed research is significant because it will fill critical knowledge gaps and identify how imaging resources should be mobilized to ensure that all AD patients are able to realize the full benefits of new Alzheimer’s treatments. The project's potential impact will be substantial because project findings will provide guidance to policymakers on imaging technology barriers to AD care, supporting planning and legislative and regulatory efforts to mitigate disparities in AD morbidity and mortality.
