Abstract Details

Title A Real-world Investigation of Demographic Disparity in Alzheimer’s Disease Progression

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 9-003

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.

Authors/Disclosures
Shruthi Venkatesh PRESENTER	Miss Venkatesh has received research support from NIH.
Lin Wang	No disclosure on file
Tianxi Cai	Tianxi Cai has nothing to disclose.
Zongqi Xia, MD, PhD	The institution of Dr. Xia has received research support from National Institute of Health. The institution of Dr. Xia has received research support from Genentech/Roche.

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