Effects of Medicare predictors in health disparities in the risk of Alzheimer's disease

IF 4.9 Q1 CLINICAL NEUROLOGY

Alzheimer''s and Dementia: Translational Research and Clinical Interventions Pub Date : 2025-04-09 DOI:10.1002/trc2.70078

Igor Akushevich, Arseniy Yashkin, Julia Kravchenko

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引用次数: 0

Abstract

INTRODUCTION

Disparities in Alzheimer's disease (AD) and related dementias (ADRD) persist across race/ethnicity, sex, and US geographic regions, but limited quantitative information exists to explain how specific predictors contribute to these disparities. Many traditional methods lack precision in addressing both exposure (higher prevalence of a predictor) and vulnerability (higher risk associated with a predictor) effects. This study introduces an approach that leverages population attributable fraction (PAF) to analyze and explain AD/ADRD disparities using Medicare data.

METHODS

We applied our method to Medicare claims data from a nationally representative sample of the US adults aged 70, 75, 80, and 85. The analysis focused on six types of disparities: Black–White, Hispanic–White, Native American–White, Asian–White, female–male, and stroke-belt versus non–stroke-belt states. Predictors included Medicare/Medicaid dual eligibility as an indicator of low income and 10 AD/ADRD-related diseases. The method quantified the exposure and vulnerability effects of each predictor on the observed disparities.

RESULTS

Low income and vulnerability to arterial hypertension were the primary contributors to AD/ADRD disparities, with cerebrovascular diseases and depression as notable secondary predictors. The exposure effect dominated for income-related disparities, while hypertension's effect was largely driven by increased vulnerability. Racial disparities (Black–White, Hispanic–White) were most affected by income and hypertension, while female–male and stroke-belt disparities were less influenced by the examined predictors.

DISCUSSION

Our findings indicate that different intervention strategies are needed to address AD/ADRD disparities. Income-related disparities require targeting exposure (e.g., socioeconomic improvements), while hypertension-related disparities suggest a focus on managing vulnerability (e.g., better control of hypertension). The developed approach offers a robust framework for explaining disparities and designing targeted interventions. Further application to other datasets and exploration of additional predictors could enhance understanding and lead to more effective prevention strategies for AD/ADRD disparities.

Highlights

Our new approach addresses disparities leveraging the concept of population attributable fraction for Cox models.
Exposure and vulnerability mechanisms of health disparity generation are evaluated.
Vulnerability to hypertension is a consistent dominant factor in Alzheimer's disease (AD) risk disparities.
Predictors explain AD disparities better in Black and Hispanic populations.
Disparities in AD are driven by exposure to socioeconomic status suggesting targeted interventions.

Abstract Image

查看原文本刊更多论文

老年痴呆症风险的医疗保险预测因素对健康差异的影响

阿尔茨海默病（AD）和相关痴呆（ADRD）的差异在种族/民族、性别和美国地理区域之间持续存在，但有限的定量信息可以解释特定预测因素如何导致这些差异。许多传统方法在处理暴露（预测因子的较高流行率）和脆弱性（与预测因子相关的较高风险）效应方面缺乏精确性。本研究引入了一种利用人口归因分数（PAF）来分析和解释使用医疗保险数据的AD/ADRD差异的方法。方法：我们将我们的方法应用于来自70岁、75岁、80岁和85岁美国成年人的全国代表性样本的医疗保险索赔数据。分析集中在六种类型的差异：黑人-白人、西班牙裔-白人、印第安人-白人、亚裔-白人、女性-男性，以及中风带州与非中风带州。预测指标包括医疗保险/医疗补助双重资格作为低收入和10种AD/ adrd相关疾病的指标。该方法量化了每个预测因子对观察到的差异的暴露和脆弱性影响。结果低收入和动脉高血压易感性是导致AD/ADRD差异的主要因素，脑血管疾病和抑郁是次要因素。暴露效应主要是与收入相关的差异，而高血压的影响主要是由脆弱性增加引起的。种族差异（黑人-白人、西班牙裔-白人）受收入和高血压的影响最大，而女性-男性和中风带差异受研究预测因素的影响较小。我们的研究结果表明，需要不同的干预策略来解决AD/ADRD差异。与收入相关的差异需要有针对性的暴露（例如，社会经济改善），而与高血压相关的差异则建议重点管理脆弱性（例如，更好地控制高血压）。开发的方法为解释差异和设计有针对性的干预措施提供了一个强有力的框架。进一步应用于其他数据集和探索其他预测因子可以增强对AD/ADRD差异的理解并产生更有效的预防策略。我们的新方法利用Cox模型的总体归因分数概念来解决差异。评估了健康差距产生的暴露和脆弱性机制。高血压易感性是阿尔茨海默病（AD）风险差异的一贯主导因素。预测者更好地解释了黑人和西班牙裔人群的AD差异。阿尔茨海默病的差异是由社会经济地位所导致的，这表明有针对性的干预措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Alzheimer''s and Dementia: Translational Research and Clinical Interventions Medicine-Psychiatry and Mental Health

CiteScore

10.10

自引率

2.10%

发文量

134

审稿时长

10 weeks

期刊介绍： Alzheimer''s & Dementia: Translational Research & Clinical Interventions (TRCI) is a peer-reviewed, open access,journal from the Alzheimer''s Association®. The journal seeks to bridge the full scope of explorations between basic research on drug discovery and clinical studies, validating putative therapies for aging-related chronic brain conditions that affect cognition, motor functions, and other behavioral or clinical symptoms associated with all forms dementia and Alzheimer''s disease. The journal will publish findings from diverse domains of research and disciplines to accelerate the conversion of abstract facts into practical knowledge: specifically, to translate what is learned at the bench into bedside applications. The journal seeks to publish articles that go beyond a singular emphasis on either basic drug discovery research or clinical research. Rather, an important theme of articles will be the linkages between and among the various discrete steps in the complex continuum of therapy development. For rapid communication among a multidisciplinary research audience involving the range of therapeutic interventions, TRCI will consider only original contributions that include feature length research articles, systematic reviews, meta-analyses, brief reports, narrative reviews, commentaries, letters, perspectives, and research news that would advance wide range of interventions to ameliorate symptoms or alter the progression of chronic neurocognitive disorders such as dementia and Alzheimer''s disease. The journal will publish on topics related to medicine, geriatrics, neuroscience, neurophysiology, neurology, psychiatry, clinical psychology, bioinformatics, pharmaco-genetics, regulatory issues, health economics, pharmacoeconomics, and public health policy as these apply to preclinical and clinical research on therapeutics.