A Real-world Investigation of Demographic Disparity in Alzheimer’s Disease Progression
Shruthi Venkatesh1, Linshanshan Wang2, Tianxi Cai2, Zongqi Xia1
1University of Pittsburgh, 2Harvard T.H. Chan School of Public Health
Objective:
We leveraged real-world data from electronic health records (EHR) to examine differences in Alzheimer’s disease (AD) progression among gender, race, and ethnicity groups.
Background:
AD carries a high societal burden that is inequitably distributed across demographic groups.
Design/Methods:
Using the EHR data of a large healthcare system from 2011 to 2022, we first identified patients with ≥1 diagnosis code for AD or related dementia and then applied a novel semi-supervised phenotyping algorithm to obtain AD diagnosis status, which was validated against gold-standard chart-reviewed and linked registry labels. We used time-to-nursing home admission and time-to-death as objective and readily ascertainable AD progression endpoints. We included patients with ≥24 months of clinical data pre-AD diagnosis and implemented competing risk Cox proportional hazard models of time-to-nursing home admission vs time-to-death to estimate survival, adjusting for baseline covariates (age, gender, race, ethnicity, healthcare utilization, and comorbidities).
Results:
Among the 8603 patients (63.4% women, 92.5% non-Hispanic white, 80.9±9.1 years of age at AD diagnosis), 44.1% of patients entered a nursing home and 42.9% died during follow-up. Non-Hispanic white patients had a lower risk of nursing home admission (HR=0.853 [0.762, 0.956], p<0.006) and higher mortality risk (HR=1.363 [1.098, 1.693], p=0.005) than other racial/ethnic minorities. There was no difference between women and men in the risk of nursing home admission (HR=1.000 [0.932, 1.072], p=0.99), but women had a lower mortality risk (HR=0.814 [0.731, 0.907], p<0.001) than men.
Conclusions:
Racial and ethnic minorities with AD have a higher risk of and faster time-to-nursing home admission, whereas non-Hispanic White patients and men with AD have a higher risk of and faster time-to-death. Further investigation of the contributors of demographic disparities can inform clinical management and potentially improve the outcomes of people with AD.