The national prevalence of diagnosed and undiagnosed Alzheimer?s disease and related dementias (ADRD) among Arab Americans is unknown. Estimates are unknown because Arab Americans are considered non- Hispanic (NH) whites in national health surveys. By using innovative methods to link National Health Interview Survey (NHIS) and Medical Expenditure Panel Survey (MEPS) data, we can disaggregate Arab Americans from the NH white classification to uncover ADRD estimates.
Specific aims are to: 1) estimate the age- and sex-adjusted prevalence of diagnosed ADRD among foreign-born Arab Americans compared to US-born NH whites and foreign-born NH whites, NH blacks, NH Asians and Hispanics; 2) examine associations between race, ethnicity and nativity status and the prevalence of diagnosed ADRD before and after controlling for covariates; 3) estimate the age- and sex-adjusted prevalence of undiagnosed ADRD among Arab Americans compared to the aforementioned groups; and 4) examine associations between race, ethnicity and nativity status and the prevalence of undiagnosed ADRD before and after controlling for covariates. Secondary, cross-sectional data from 2000-2016 NHIS and 2001-2017 MEPS data sources will be combined and analyzed. Responses will be matched, and a linked dataset will be created by the Agency for Healthcare Research and Quality. The sample will include adults >45 years. The independent variable will be created by combining questions assessing race, ethnicity and nativity status from NHIS. Foreign-born Arab Americans will be compared to US-born NH whites and foreign-born NH whites, NH blacks, NH Asians and Hispanics.
For Aims 1 and 2, the dependent variable is diagnosed ADRD, measured using data from MEPS medical condition files. Adults with ICD-9 codes 290, 294, 331, 797 (2001-2015) or ICD-10 codes F03 or G30 (2016-2017) will be classified as has having diagnosed ADRD.
For Aims 3 and 4, the dependent variable is undiagnosed ADRD, measured using MEPS medical condition and household component files. The MEPS asks three questions to estimate cognitive limitations, an indicator of ADRD. Adults will be categorized as having undiagnosed ADRD if: 1) they responded ?yes? to one or more questions on cognitive limitations and 2) do not have diagnosed ADRD. Age and sex adjusted prevalence of diagnosed ADRD (Aim 1) and undiagnosed ADRD (Aim 3) will be calculated for Arab Americans compared to US-born NH whites and foreign-born NH whites, blacks, Hispanics and Asians. Logistic regression will be used to determine associations between the combined race, ethnicity and nativity status variable and diagnosed ADRD (Aim 2), and undiagnosed ADRD (Aim 4) before and after controlling for covariates. The innovative method used in this study will contribute the first estimates of diagnosed and undiagnosed ADRD among Arab Americans to the medical literature. Results will help to facilitate policy decisions and advocate for resources to be allocated for interventions to improve the health of this underrepresented but increasingly visible vulnerable population.
The proposed research is relevant to public health because it will address a fundamental lack of knowledge on racial and ethnic disparities in the prevalence of undiagnosed and diagnosed Alzheimer?s disease and related dementias (ADRD) among Arab Americans compared to other US- and foreign-born racial and ethnic groups. This research is worthwhile and significant because: 1) it will contribute to a body of literature disaggregating Arab Americans from non-Hispanic whites which demonstrates that Arab Americans have poorer health outcomes; 2) research suggests Arab Americans experience perceived institutional and interpersonal discrimination, which affects their mental and personal health; 3) Arab Americans do not fit the model of the ?immigrant health paradox? and research suggests that US-born Arab Americans are healthier than foreign- born Arab Americans; 4) the Arab American population in the US has grown significantly in the past 40 years; and 5) although previous studies have provided estimates of ADRD among racial and ethnic minority groups, the national prevalence of ADRD among Arab Americans is unknown because they are considered non- Hispanic whites in national health surveys. This research meets the mission of the National Institute on Aging (NIA) by conducting social epidemiologic research on aging and fostering the development of an early stage investigator as a clinician scientist in aging.