Addressing racial/ethnic geographic disparities in COVID-19 health services and outcomes among nursing home residents with ADRD

PROJECT SUMMARY Racial/ethnic health disparities exist for a wide array of nursing home (NH) services and health outcomes. These disparities directly impact the care received by older adults in NHs. Alzheimer's Disease and Related Dementias (ADRD) serve as a "disparity multiplier," in that Black and Hispanic NH residents have worse health outcomes and these differences are more pronounced for residents with ADRD. The importance of the intersection and severity of racial/ethnic health disparities and ADRD has been highlighted by the COVID-19 pandemic, which has disproportionately impacted NH residents and those with ADRD. The pandemic has also revealed how significantly these disparities may vary by geography. Despite the differences in COVID-19 outcomes by race/ethnicity and geography, and the potential exacerbation of these disparities by ADRD status, little evidence exists to reveal exactly how or to what extent race/ethnicity, geography, and ADRD status intersect to jointly impact the health outcomes of older NH residents. Additionally, the optimal methods for estimating wide-ranging health disparities between racially/ethnically diverse subpopulations of varying sizes and demographics across geographic units remain unclear. The long-term objective of the proposed research is therefore to develop a causal inference framework for studying racial/ethnic health disparities across different geographic units. Aim 1 will identify the most appropriate analytic approaches for quantifying racial/ethnic disparities across geographic units by conducting a simulation study comparing several existing biostatistical methods. Aim 2 will leverage these results to quantify health disparities in COVID-19 vaccine use and outcomes by racial/ethnic status, ADRD status, and geography through the use of a first-of-its-kind database of electronic medical records linked to Medicare claims data from approximately 10,000 US NHs. This research will provide some of the first empirical evidence for policymakers and other stakeholders that can be used to improve health equity for COVID-19 and other conditions. It will also establish unique methods that can be used broadly to conduct accurate, timely, and relevant future studies of disparities among NH residents and other populations. These proposed studies will be completed by the principal investigator with support from collaborators with deep expertise in advanced statistical methods, health disparities, infectious disease epidemiology, geriatrics, and ADRD. The principal investigator is supported by a collaborative and interdisciplinary research environment that includes the Center for Gerontology and Health Care Research at the Brown University School of Public Health. The training activities detailed in this application are focused on advancing quantitative computational skills and developing a deep contextual knowledge of racial/ethnic health disparities and the care of older adults with ADRD; they will prepare the principal investigator for a career as an independent epidemiologist and health services researcher.