1
|
Silva-Rudberg JA, Carrión CI, Pérez-Palmer N, Li J, Mehta SK, Diab NS, Mecca AP, O'Dell RS. Assessment of disparities in timely diagnosis and comprehensive workup of cognitive impairment between English and Spanish speakers. Am J Geriatr Psychiatry 2024; 32:773-786. [PMID: 38336573 PMCID: PMC11162952 DOI: 10.1016/j.jagp.2024.01.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 01/13/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Previous studies have examined disparities in dementia care that affect the U.S. Hispanic/Latino population, including clinician bias, lack of cultural responsiveness, and less access to health care. However, there is limited research that specifically investigates the impact of language barriers to health disparities in dementia diagnosis. METHODS In this retrospective cross-sectional study, 12,080 English- or Spanish- speaking patients who received an initial diagnosis of mild cognitive impairment (MCI) or dementia between July 2017 and June 2019 were identified in the Yale New Haven Health (YNHH) electronic medical record. To evaluate the timeliness of diagnosis, an initial diagnosis of MCI was classified as "timely", while an initial diagnosis of dementia was considered "delayed." Comprehensiveness of diagnosis was assessed by measuring the presence of laboratory studies, neuroimaging, specialist evaluation, and advanced diagnostics six months before or after diagnosis. Binomial logistic regressions were calculated with and without adjustment for age, legal sex, ethnicity, neighborhood disadvantage, and medical comorbidities. RESULTS Spanish speakers were less likely to receive a timely diagnosis when compared with English speakers both before (unadjusted OR, 0.65; 95% CI, 0.53-0.80, p <0.0001) and after adjusting for covariates (adjusted OR, 0.55; 95% CI, 0.40-0.75, p = 0.0001). Diagnostic services were provided equally between groups, except for referrals to geriatrics, which were more frequent among Spanish-speaking patients. A subgroup analysis revealed that Spanish-speaking Hispanic/Latino patients were less likely to receive a timely diagnosis compared to English-speaking Hispanic/Latino patients (adjusted OR, 0.53; 95% CI, 0.38-0.73, p = 0.0001). CONCLUSIONS Non-English language preference is likely to be a contributing factor to timely diagnosis of cognitive impairment. In this study, Spanish language preference rather than Hispanic/Latino ethnicity was a significant predictor of a less timely diagnosis of cognitive impairment. Policy changes are needed to reduce barriers in cognitive disorders care for Spanish-speaking patients.
Collapse
Affiliation(s)
- Jason A Silva-Rudberg
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Medicine (JAS-R,), University of California, San Francisco, San Francisco, CA
| | - Carmen I Carrión
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Neurology (CIC), Yale University School of Medicine, New Haven, CT
| | - Nicolás Pérez-Palmer
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (NP-P), Veteran's Affairs Connecticut Healthcare System, West Haven, CT
| | - Judy Li
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Sumarth K Mehta
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Nicholas S Diab
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Adam P Mecca
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Ryan S O'Dell
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT.
| |
Collapse
|
2
|
Ruppert EP, Rocha JVDF, da Silva AL, Tomaz KLDS, Friedlaender CV, Assenção JDCM, Rincon LP, Ribeiro NGF, Santos DCDS, Lima APZ, Allen IE, Caramelli P, Grinberg LT, Maciel FIP, Resende EDPF. Episodic memory improvement in illiterate adults attending late-life education irrespective of low socioeconomic status: insights from the PROAME study. Dement Neuropsychol 2024; 18:e20230098. [PMID: 38957727 PMCID: PMC11218930 DOI: 10.1590/1980-5764-dn-2023-0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/29/2024] [Accepted: 03/03/2024] [Indexed: 07/04/2024] Open
Abstract
The majority of people with dementia live in low or middle-income countries (LMICs) where resources that play a crucial role in brain health, such as quality education, are still not widely available. In Brazil, illiteracy remains a prevalent issue, especially in communities with lower socioeconomic status (SES). The PROAME study set out to explore basic education in illiterate adults as a means to improve cognitive reserve. Objective This manuscript aims to explore the relationship between SES and learning, as well as cognitive outcomes, in an older illiterate population. Methods This six-month clinical trial (NCT04473235) involved 108 participants, of which 77 concluded all assessments, enrolled in late-life basic education. SES assessments included Quality of Urban Living Index, Municipal Human Development Index and Household SES calculated for each participant. Cognitive assessments encompassed the Free and Cued Selective Reminding Test (FCSRT), a word list to assess reading, and the Beta III matrix. Results The sample consisted primarily of women, with a mean age of 58.5. Participants improved their reading (p=0.01) and their FCSRT (p=0.003). Regarding episodic memory, women outperformed men (p=0.007) and younger participants improved more than their older counterparts (p=0.001). There was no association observed between SES and cognitive outcomes. Conclusion Irrespective of SES, participants demonstrated positive outcomes after attending basic education. These findings highlight that late life education could be an important non-pharmacologic preventative measure, especially in LMICs.
Collapse
Affiliation(s)
- Emma Patrice Ruppert
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte MG, Brazil
- University of Pittsburgh, Pascoal Lab, Pittsburgh PA, USA
| | - João Victor de Faria Rocha
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Pesquisa Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Belo Horizonte MG, Brazil
| | | | - Kelle Luisa Dos Santos Tomaz
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Pesquisa Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil
| | - Clarisse Vasconcelos Friedlaender
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Pesquisa Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Belo Horizonte MG, Brazil
| | - Joanna de Castro Magalhães Assenção
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Pesquisa Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil
| | - Luciana Paula Rincon
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Pesquisa Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil
| | - Norton Gray Ferreira Ribeiro
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Pesquisa Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil
| | | | | | - Isabel Elaine Allen
- University of California San Francisco, Global Brain Health Institute, San Francisco CA, USA
| | - Paulo Caramelli
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Pesquisa Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil
| | - Lea Tenenholz Grinberg
- University of California San Francisco, Global Brain Health Institute, San Francisco CA, USA
- University of California, Memory and Aging Center, UCSF Weill Institute for Neurosciences, San Francisco CA, USA
| | - Francisca Izabel Pereira Maciel
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Pesquisa Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil
| | - Elisa de Paula França Resende
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte MG, Brazil
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Pesquisa Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil
- University of California San Francisco, Global Brain Health Institute, San Francisco CA, USA
| |
Collapse
|
3
|
Safai A, Jonaitis E, Langhough RE, Buckingha WR, Johnson SC, Powell WR, Kind AJH, Bendlin BB, Tiwari P. Association of neighborhood disadvantage with cognitive function and cortical disorganization in an unimpaired cohort. ARXIV 2024:arXiv:2406.13822v1. [PMID: 38947926 PMCID: PMC11213155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Objective Neighborhood disadvantage is associated with worse health and cognitive outcomes. Morphological similarity network (MSN) is a promising approach to elucidate cortical network patterns underlying complex cognitive functions. We hypothesized that MSNs could capture intricate changes in cortical patterns related to neighborhood disadvantage and cognitive function, potentially explaining some of the risk for later life cognitive impairment among individuals who live in disadvantaged contexts. Methods This cross-sectional study included cognitively unimpaired participants (n=524, age=62.96±8.377, gender (M:F)=181:343, ADI(L:H) =450,74) from the Wisconsin Alzheimer's Disease Research Center or Wisconsin Registry for Alzheimer's Prevention. Neighborhood disadvantage status was obtained using the Area Deprivation Index (ADI). Cognitive performance was assessed through six tests evaluating memory, executive functioning, and the modified preclinical Alzheimer's cognitive composite (mPACC). Morphological Similarity Networks (MSN) were constructed for each participant based on the similarity in distribution of cortical thickness of brain regions, followed by computation of local and global network features. We used linear regression to examine ADI associations with cognitive scores and MSN features. The mediating effect of MSN features on the relationship between ADI and cognitive performance was statistically assessed. Results Neighborhood disadvantage showed negative association with category fluency, implicit learning speed, story recall and mPACC scores, indicating worse cognitive function among those living in more disadvantaged neighborhoods. Local network features of frontal and temporal brain regions differed based on ADI status. Centrality of left lateral orbitofrontal region showed a partial mediating effect between association of neighborhood disadvantage and story recall performance. Conclusion Our findings suggest differences in local cortical organization by neighborhood disadvantage, which also partially mediated the relationship between ADI and cognitive performance, providing a possible network-based mechanism to, in-part, explain the risk for poor cognitive functioning associated with disadvantaged neighborhoods. Future work will examine the exposure to neighborhood disadvantage on structural organization of the brain.
Collapse
Affiliation(s)
- Apoorva Safai
- Departments of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Erin Jonaitis
- Wisconsin Alzheimer's Institute, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
| | - Rebecca E Langhough
- Wisconsin Alzheimer's Institute, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Madison, WI, USA
| | - William R Buckingha
- Health Services and Care Research Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sterling C Johnson
- Wisconsin Alzheimer's Institute, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Madison, WI, USA
| | - W Ryan Powell
- Health Services and Care Research Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Amy J H Kind
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Madison, WI, USA
- Health Services and Care Research Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Barbara B Bendlin
- Wisconsin Alzheimer's Institute, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Madison, WI, USA
| | - Pallavi Tiwari
- Departments of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
4
|
Reuben A, Richmond‐Rakerd LS, Milne B, Shah D, Pearson A, Hogan S, Ireland D, Keenan R, Knodt AR, Melzer T, Poulton R, Ramrakha S, Whitman ET, Hariri AR, Moffitt TE, Caspi A. Dementia, dementia's risk factors and premorbid brain structure are concentrated in disadvantaged areas: National register and birth-cohort geographic analyses. Alzheimers Dement 2024; 20:3167-3178. [PMID: 38482967 PMCID: PMC11095428 DOI: 10.1002/alz.13727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/15/2023] [Accepted: 01/11/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Dementia risk may be elevated in socioeconomically disadvantaged neighborhoods. Reasons for this remain unclear, and this elevation has yet to be shown at a national population level. METHODS We tested whether dementia was more prevalent in disadvantaged neighborhoods across the New Zealand population (N = 1.41 million analytic sample) over a 20-year observation. We then tested whether premorbid dementia risk factors and MRI-measured brain-structure antecedents were more prevalent among midlife residents of disadvantaged neighborhoods in a population-representative NZ-birth-cohort (N = 938 analytic sample). RESULTS People residing in disadvantaged neighborhoods were at greater risk of dementia (HR per-quintile-disadvantage-increase = 1.09, 95% confidence interval [CI]:1.08-1.10) and, decades before clinical endpoints typically emerge, evidenced elevated dementia-risk scores (CAIDE, LIBRA, Lancet, ANU-ADRI, DunedinARB; β's 0.31-0.39) and displayed dementia-associated brain structural deficits and cognitive difficulties/decline. DISCUSSION Disadvantaged neighborhoods have more residents with dementia, and decades before dementia is diagnosed, residents have more dementia-risk factors and brain-structure antecedents. Whether or not neighborhoods causally influence risk, they may offer scalable opportunities for primary dementia prevention.
Collapse
Affiliation(s)
- Aaron Reuben
- Department of Psychology and NeuroscienceDuke UniversityDurhamNorth CarolinaUSA
- Department of Psychiatry and Behavioral SciencesMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | | | - Barry Milne
- Centre for Methods and Policy Application in Society SciencesUniversity of AucklandAucklandNew Zealand
| | - Devesh Shah
- Department of Psychology and NeuroscienceDuke UniversityDurhamNorth CarolinaUSA
| | - Amber Pearson
- Department of Geography, Environment, and Spatial SciencesMichigan State UniversityEast LansingMichiganUSA
- Department of Public HealthUniversity of OtagoWellingtonNew Zealand
| | - Sean Hogan
- Dunedin Multidisciplinary Health and Development Research Unit, Department of PsychologyUniversity of OtagoDunedinNew Zealand
| | - David Ireland
- Brain Health Research Centre, Department of PsychologyUniversity of OtagoDunedinNew Zealand
| | - Ross Keenan
- Brain Health Research Centre, Department of PsychologyUniversity of OtagoDunedinNew Zealand
| | - Annchen R. Knodt
- Department of Psychology and NeuroscienceDuke UniversityDurhamNorth CarolinaUSA
| | - Tracy Melzer
- Department of MedicineUniversity of OtagoChristchurchNew Zealand
| | - Richie Poulton
- Dunedin Multidisciplinary Health and Development Research Unit, Department of PsychologyUniversity of OtagoDunedinNew Zealand
| | - Sandhya Ramrakha
- Dunedin Multidisciplinary Health and Development Research Unit, Department of PsychologyUniversity of OtagoDunedinNew Zealand
| | - Ethan T. Whitman
- Department of Psychology and NeuroscienceDuke UniversityDurhamNorth CarolinaUSA
| | - Ahmad R. Hariri
- Department of Psychology and NeuroscienceDuke UniversityDurhamNorth CarolinaUSA
| | - Terrie E. Moffitt
- Department of Psychology and NeuroscienceDuke UniversityDurhamNorth CarolinaUSA
- Department of Psychiatry and Behavioral SciencesDuke UniversityDurhamNorth CarolinaUSA
- King's College London, Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, & NeuroscienceLondonUK
- PROMENTA, Department of PsychologyUniversity of OsloOsloNorway
| | - Avshalom Caspi
- Department of Psychology and NeuroscienceDuke UniversityDurhamNorth CarolinaUSA
- Department of Psychiatry and Behavioral SciencesDuke UniversityDurhamNorth CarolinaUSA
- King's College London, Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, & NeuroscienceLondonUK
- PROMENTA, Department of PsychologyUniversity of OsloOsloNorway
| |
Collapse
|
5
|
Vintimilla R, Benton A, Morakabian R, Hall JR, Johnson LA, O'Bryant SE. The Association of Neighborhood Socioeconomic Status with Executive Function and Processing Speed in Cognitively Normal Mexican American Elders from the Health and Aging Brains Study: Health Disparities Cohort. Dement Geriatr Cogn Disord 2024:1-10. [PMID: 38663362 DOI: 10.1159/000539035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/20/2024] [Indexed: 05/09/2024] Open
Abstract
INTRODUCTION Neighborhood socioeconomic status (NSES) has been linked with overall health, and this study will evaluate whether NSES is cross-sectionally associated with cognition in non-Hispanic whites (NHWs) and Mexican Americans (MAs) from the Health and Aging Brain: Health Disparities Study (HABS-HD). METHODS The HABS-HD is a longitudinal study conducted at the University of North Texas Health Science Center. The final sample analyzed (n = 1,312) were 50 years or older, with unimpaired cognition, and underwent an interview, neuropsychological examination, imaging, and blood draw. NSES was measured using the national area deprivation index (ADI) percentile ranking, which considered socioeconomic variables. Executive function and processing speed were assessed by the trail making tests (A and B) and the digit-symbol substitution test, respectively. Linear regression was used to assess the association of ADI and cognitive measures. RESULTS MAs were younger, more likely to be female, less educated, had higher ADI scores, performed worse on trails B (all p < 0.05), and had lower prevalence of APOE4 + when compared to NHWs (p < 0.0001). A higher percentage of MAs lived in the most deprived neighborhoods than NHWs. For NHWs, ADI did not predict trails B or DSS scores, after adjusting for demographic variables and APOE4. For MAs, ADI predicted trails A, trails B, and DSS after adjusting for demographic covariates and APOE4 status. CONCLUSION Our study revealed that living in an area of higher deprivation was associated with lower cognitive function in MAs but not in NHWs, which is important to consider in future interventions to slow cognitive decline.
Collapse
Affiliation(s)
- Raul Vintimilla
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Abigail Benton
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Roya Morakabian
- Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA
| | - James R Hall
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Leigh A Johnson
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Sid E O'Bryant
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth, Texas, USA
| |
Collapse
|
6
|
Kim B, Yannatos I, Blam K, Wiebe D, Xie SX, McMillan CT, Mechanic‐Hamilton D, Wolk DA, Lee EB. Neighborhood disadvantage reduces cognitive reserve independent of neuropathologic change. Alzheimers Dement 2024; 20:2707-2718. [PMID: 38400524 PMCID: PMC11032541 DOI: 10.1002/alz.13736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Individuals in socioeconomically disadvantaged neighborhoods exhibit increased risk for impaired cognitive function. Whether this association relates to the major dementia-related neuropathologies is unknown. METHODS This cross-sectional study included 469 autopsy cases from 2011 to 2023. The relationships between neighborhood disadvantage measured by Area Deprivation Index (ADI) percentiles categorized into tertiles, cognition evaluated by the last Mini-Mental State Examination (MMSE) scores before death, and 10 dementia-associated proteinopathies and cerebrovascular disease were assessed using regression analyses. RESULTS Higher ADI was significantly associated with lower MMSE score. This was mitigated by increasing years of education. ADI was not associated with an increase in dementia-associated neuropathologic change. Moreover, the significant association between ADI and cognition remained even after controlling for changes in major dementia-associated proteinopathies or cerebrovascular disease. DISCUSSION Neighborhood disadvantage appears to be associated with decreased cognitive reserve. This association is modified by education but is independent of the major dementia-associated neuropathologies.
Collapse
Affiliation(s)
- Boram Kim
- Translational Neuropathology Research LaboratoryDepartment of Pathology and Laboratory MedicinePerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Isabel Yannatos
- Penn Frontotemporal Degeneration CenterDepartment of NeurologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kaitlin Blam
- Translational Neuropathology Research LaboratoryDepartment of Pathology and Laboratory MedicinePerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Douglas Wiebe
- Department of Emergency MedicineDepartment of EpidemiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Sharon X. Xie
- Department of BiostatisticsEpidemiology and InformaticsPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Corey T. McMillan
- Penn Frontotemporal Degeneration CenterDepartment of NeurologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Dawn Mechanic‐Hamilton
- Penn Memory CenterDepartment of NeurologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - David A. Wolk
- Penn Memory CenterDepartment of NeurologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Edward B. Lee
- Translational Neuropathology Research LaboratoryDepartment of Pathology and Laboratory MedicinePerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| |
Collapse
|
7
|
Gill AS, Tullis B, Mace JC, Massey C, Pandrangi VC, Gutierrez JA, Ramakrishnan VR, Beswick DM, Soler ZM, Smith TL, Alt JA. Health care disparities and chronic rhinosinusitis: Does neighborhood disadvantage impact outcomes in sinonasal disease? Int Forum Allergy Rhinol 2024. [PMID: 38367249 DOI: 10.1002/alr.23337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/04/2024] [Accepted: 01/30/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE Socioeconomic status (SES) is linked to health outcomes but has not been well studied in patients with chronic rhinosinusitis (CRS). The area deprivation index (ADI) is a comprehensive measure of geographic SES that ranks neighborhood disadvantage. This investigation used ADI to understand the impact of neighborhood disadvantage on CRS treatment outcomes. METHODS A total of 642 study participants with CRS were prospectively enrolled and self-selected endoscopic sinus surgery (ESS) or continued appropriate medical therapy as treatment. The 22-item SinoNasal Outcome Test (SNOT-22) and Medical Outcomes Study Questionnaire Short-Form 6-D (SF-6D) health utility value scores were recorded pre- and post-treatment. Using residence zip codes, national ADI scores were retrospectively assigned to patients. Spearman's correlation coefficients (Rs) and Cramer's V effect size (φc ) with 95% confidence interval (CI) were calculated. RESULTS A history of ESS was associated with significantly worse ADI scores compared to no history of ESS (φc = 0.18; 95% CI: 0.10, 0.25; p < 0.001). Baseline total SNOT-22 (Rs = 0.14; 95% CI: 0.06, 0.22; p < 0.001) and SF-6D values (Rs = -0.20; 95% CI: -0.27, -0.12; p < 0.001) were significantly negatively correlated with national ADI rank. No significant correlations between ADI and within-subject improvement, or achievement of >1 minimal clinically important difference, in SNOT-22 or SF-6D scores after treatment were found. CONCLUSIONS Geographic socioeconomic deprivation was associated with worse baseline disease severity and history of prior surgical intervention. However, ADI did not correlate with improvement in disease-specific outcomes. The impact of socioeconomic deprivation on outcomes in CRS requires further investigation.
Collapse
Affiliation(s)
- Amarbir S Gill
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Benton Tullis
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Jess C Mace
- Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University (OHSU), Portland, Oregon, USA
| | - Conner Massey
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Vivek C Pandrangi
- Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University (OHSU), Portland, Oregon, USA
| | - Jorge A Gutierrez
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Vijay R Ramakrishnan
- Department of Otolaryngology-Head and Neck Surgery, University of Indiana, Indianapolis, Indiana, USA
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Timothy L Smith
- Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University (OHSU), Portland, Oregon, USA
| | - Jeremiah A Alt
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
8
|
Chen A, Li Q, Huang Y, Li Y, Chuang YN, Hu X, Guo S, Wu Y, Guo Y, Bian J. Feasibility of Identifying Factors Related to Alzheimer's Disease and Related Dementia in Real-World Data. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.10.24302621. [PMID: 38405723 PMCID: PMC10889002 DOI: 10.1101/2024.02.10.24302621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
A comprehensive view of factors associated with AD/ADRD will significantly aid in studies to develop new treatments for AD/ADRD and identify high-risk populations and patients for prevention efforts. In our study, we summarized the risk factors for AD/ADRD by reviewing existing meta-analyses and review articles on risk and preventive factors for AD/ADRD. In total, we extracted 477 risk factors in 10 categories from 537 studies. We constructed an interactive knowledge map to disseminate our study results. Most of the risk factors are accessible from structured Electronic Health Records (EHRs), and clinical narratives show promise as information sources. However, evaluating genomic risk factors using RWD remains a challenge, as genetic testing for AD/ADRD is still not a common practice and is poorly documented in both structured and unstructured EHRs. Considering the constantly evolving research on AD/ADRD risk factors, literature mining via NLP methods offers a solution to automatically update our knowledge map.
Collapse
Affiliation(s)
- Aokun Chen
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Rd, Suite 7000, Gainesville, FL 32610
| | - Qian Li
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Rd, Suite 7000, Gainesville, FL 32610
| | - Yu Huang
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Rd, Suite 7000, Gainesville, FL 32610
| | - Yongqiu Li
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Rd, Suite 7000, Gainesville, FL 32610
| | - Yu-Neng Chuang
- Department of Computer Science, George R. Brown School of Engineering, Rice University, 6100 Main St., Houston, TX 77005
| | - Xia Hu
- Department of Computer Science, George R. Brown School of Engineering, Rice University, 6100 Main St., Houston, TX 77005
| | - Serena Guo
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, 1225 Center Drive, Gainesville, FL 32610
| | - Yonghui Wu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Rd, Suite 7000, Gainesville, FL 32610
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Rd, Suite 7000, Gainesville, FL 32610
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Rd, Suite 7000, Gainesville, FL 32610
| |
Collapse
|
9
|
Charkowick SV, Logothetis CN, Tsay K, Jordan A, Hanna C, Zhang S, Coughlin E, Weppelmann TA, Mhaskar R, Oxner A. A Retrospective Analysis of Vitamin D Levels in Hospitalized COVID-19 Patients With Suspected Pulmonary Embolism. Cureus 2023; 15:e41805. [PMID: 37575807 PMCID: PMC10422855 DOI: 10.7759/cureus.41805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Despite using anti-coagulation therapy in hospitalized coronavirus disease 2019 (COVID-19) patients, they have high rates of pulmonary embolism (PE) and deep vein thrombosis (DVT). The main objective of this study was to evaluate the association between vitamin D deficiency and thrombotic events (defined as the occurrence of a new PE or DVT) in hospitalized COVID-19 patients. Materials and Methods This was a retrospective, cross-sectional study of 208 hospitalized COVID-19 patients who received a computed tomographic pulmonary angiography (CTPA) based on clinical suspicion of PE between January 1, 2020, and February 5, 2021. A <20 ng/mL serum vitamin D level was used to categorize vitamin D deficiency. Nonparametric tests and multivariate binary logistic regression were used to evaluate the association between serum vitamin D levels and clinical outcomes. Results The mean vitamin D level was 26.7±13.0 ng/mL (n=208), and approximately one-third of patients were vitamin D deficient (n=68, 32.7%). No association was found between vitamin D deficiency and the occurrence of thrombotic events. The incidence of PE was 19.1% in vitamin D deficient patients compared to 11.4% in vitamin D sufficient patients (p=0.13). Vitamin D deficiency was positively associated with ICU admission (OR 3.047, 95%CI 1.57-5.91, p=0.001) and mortality (OR 3.76, 95%CI 1.29-11.01, p=0.016). Conclusions This study found no association between vitamin D deficiency and the occurrence of a new PE or DVT in hospitalized COVID-19 patients. Patients with vitamin D deficiency were more likely to be admitted to the ICU and had increased overall mortality.
Collapse
Affiliation(s)
- Shaun V Charkowick
- College of Medicine, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Constantine N Logothetis
- Department of Internal Medicine, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Katherine Tsay
- College of Medicine, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Aryanna Jordan
- Department of Internal Medicine, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Catherine Hanna
- College of Medicine, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Sherry Zhang
- College of Medicine, University of South Florida Health Morsani College of Medicine, Tampa, USA
- Department of Medicine, Kaiser Permanente Oakland Medical Center, Oakland, USA
| | - Emily Coughlin
- College of Medicine, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Thomas A Weppelmann
- Department of Ophthalmology, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Asa Oxner
- Department of Internal Medicine, University of South Florida Health Morsani College of Medicine, Tampa, USA
| |
Collapse
|