Abstract
Impact of Social Determinants of Health on Delirium and Dementia
Mfon Umoh, MD, PhD, Assistant Professor, Johns Hopkins School of Medicine
The overarching goal of this pilot proposal is to examine the distribution of specialized ADRD diagnosis, treatment, and care resources nationally and to understand and anticipate potential impacts of differential access to these resourced. This cross-sectional study will create a novel composite measure of ADRD resource richness at the county level, incorporating dementia specialists, anti-amyloid antibody infusion centers, amyloid PET CT sites, Alzheimer's Disease Research Centers, and GUIDE programs. We will use publicly available data sources including Medicare provider files, online databases, and artificial intelligence-driven searches to identify resources. County-level analysis will examine associations with location and population characteristics using ordinal logistic regression. We will link resource data to Medicare claims data to examine associations with clinical outcomes.
Specific Aims:
Aim 1: To characterize variation in the availability of specialized ADRD diagnosis, treatment, and care resources by location and population characteristics.
Aim 2: To determine the association between availability of specialized ADRD diagnosis, treatment, and care resources and age at ADRD diagnosis, mortality, and time from diagnosis to death.
This pilot study will produce the first comprehensive characterization of emerging ADRD resource distribution, create a novel county-level resource richness measure with geographic mapping, and provide preliminary evidence of associations between resource availability and diagnosis timing and outcomes. Results will inform policy discussions about access to new ADRD treatments and generate preliminary data for future R01 applications examining patient-centered outcomes of differential resource access. As new ADRD diagnostics, treatments, and care models become available, understanding their geographic and demographic distribution is crucial for ensuring access and optimizing care delivery across all populations.