Dataset Information

Complex interactions underlie racial disparity in the risk of developing Alzheimer's disease dementia.

ABSTRACT:

Introduction

We aim to determine racial disparities and their modifying factors in risk for Alzheimer's disease (AD) dementia among cognitively normal individuals 65 years or older.

Methods

Longitudinal data from the National Alzheimer's Coordinating Center Uniform Data Set on 1229 African Americans (AAs) and 6679 whites were analyzed for the risk of AD using competing risk models with death as a competing event.

Results

Major AD risk factors modified racial differences which, when statistically significant, occurred only with older age among APOE ε4 negative individuals, but also with younger age among APOE ε4 positive individuals. The racial differences favored AAs among individuals with body mass index (BMI) < 30, but whites among individuals with a high BMI (≥ 30), and were additionally modified by sex, education, hypertension, and smoking status.

Conclusions

The presence, direction, and relative magnitude of racial disparity for AD represent an interactive function of major AD and cerebrovascular risk factors.

SUBMITTER: Xiong C

PROVIDER: S-EPMC7259475 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Publications

Complex interactions underlie racial disparity in the risk of developing Alzheimer's disease dementia.

Xiong Chengjie C Luo Jingqin J Coble Dean D Agboola Folasade F Kukull Walter W Morris John C JC

Alzheimer's & dementia : the journal of the Alzheimer's Association 20200217 4

<h4>Introduction</h4>We aim to determine racial disparities and their modifying factors in risk for Alzheimer's disease (AD) dementia among cognitively normal individuals 65 years or older.<h4>Methods</h4>Longitudinal data from the National Alzheimer's Coordinating Center Uniform Data Set on 1229 African Americans (AAs) and 6679 whites were analyzed for the risk of AD using competing risk models with death as a competing event.<h4>Results</h4>Major AD risk factors modified racial differences whi ...[more]

PMID: 32067357

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Project description:ObjectiveExplore within and across nursing home (NH) racial disparities in end-of-life (EOL) hospitalizations for residents with Alzheimer's disease or related dementia (ADRD), and examine whether severe cognitive impairment influences these relationships.DesignObservational study merging, at the individual level, C2014-2017 national-level Minimum Data Set (MDS), Medicare Beneficiary Summary Files (MBSF), and Medicare Provider Analysis and Review (MedPAR). Nursing Home Compare (NHC) was also used.SettingLong-stay residents who died in a NH or a hospital within 8 days of discharge.ParticipantsAnalytical sample included 665,033 decedent residents with ADRD in 14,595 facilities.Main outcomes and measuresThe outcome was hospitalization within 30 days of death. Key independent variables were race, severe cognitive impairment, and NH-level proportion of black residents. Other covariates included socio-demographics, dual eligibility, hospice enrollment, and chronic conditions. Facility-level characteristics were also included (e.g. profit status, staffing hours, etc.). We fit linear probability models with robust standard errors, fixed and random effects.ResultsCompared to whites, black decedents had a significantly (p < 0.01) higher risk of EOL hospitalizations (7.88%). Among those with severe cognitive impairment, whites showed a lower risk of hospitalizations (6.04%). But EOL hospitalization risk among blacks with severe cognitive impairment was still significantly elevated (β = 0.0494; p < 0.01). A comparison of the base model with the fixed and random-effects models showed statistically significant hospitalization risk by decedent's race both within and across facilities.Conclusions and relevanceWe found disparities between black and white residents with ADRD both within and across facilities. The within-facility disparities may be due to residents' preferences and/or NH practices that contribute to differential treatment. The across facility differences point to the overall quality of care disparities in homes with a higher prevalence of black residents. Persistence of such systemic disparities among the most vulnerable individuals is extremely troubling.

Dataset Information

Complex interactions underlie racial disparity in the risk of developing Alzheimer's disease dementia.

Introduction

Methods

Results

Conclusions

Publications

Complex interactions underlie racial disparity in the risk of developing Alzheimer's disease dementia.

Similar Datasets

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