Effectiveness of therapeutics and health care services in reducing racial disparities in Alzheimer's disease
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Effectiveness of therapeutics and health care services in reducing racial disparities in Alzheimer's disease (PI: Zissimopoulos) Project Summary The origins of racial disparities in Alzheimer's disease are multifaceted ranging from risk of AD, to access to care, to delivery of care, to genetic variance in response to care. In the proposed program of research, we will approach the challenge of racial and ethnic disparities in Alzheimer's disease (AD) from two perspectives: use of and response to drug therapies for non‐AD conditions that influence risk of AD and; health care treatments for AD. Our goals are to identify racial and ethnic differences in both and, once identified, elucidate opportunities for potential AD prevention and treatment regimens across diverse populations. To achieve these goals, we will conduct analyses using longitudinal Medicare claims data on over 10 million persons per year. Medicare claims data have several advantages over other types of data such as clinical trial data, survey data or data from electronic medical records: 1) Medicare beneficiaries are of the age group at greatest risk for AD, persons ages 65 or older, beneficiaries are of both sexes and all races and come from diverse socioeconomic backgrounds; 2) the magnitude of the Medicare population provides sufficient number of persons by sex and by race to conduct statically powered analyses; 3) data contain details on all prescribed drug therapies and health care treatments and services reimbursed by Medicare and they are not limited by error in self‐report measures common in survey data. Aim 1 will identify drug therapies currently used to treat non‐AD conditions that may affect AD risk. Expert panelists will help prioritize the evidence and provide insight into probable variations across sex, race and ethnicity. Aim 2 will analyze the influence of these drug treatments on incidence of AD and differences in the association across sex, race and ethnicity. Aim 3 will evaluate racial disparities in AD diagnoses and treatments over time, including diagnosis methods; the specialties of diagnosing physicians; initiation and use of AD and other psychotropic drugs; timing and regularity of physician visits; and the factors associated with differences across diverse race and ethnic populations. This research will inform drug targets and the design of clinical trials, as well as AD treatment and care interventions to reduce racial disparities in combating the disease.
