PEDAL Lab Presentations at APHA 2019 Annual Meeting and Expo

The PEDAL lab had one team member and two affiliated researchers present at the American Public Health Association’s 2019 Annual Meeting and Expo here in Philadelphia. Additionally, Jordan Weiss won a prestigious national award for his PEDAL-lab related research.

PEDAL Lab team member Melissa Oney, PhD presented her poster “Out-of-Pocket Costs for Dementia: A Longitudinal Perspective” presenting research that she completed with PEDAL lab Director Norma B. Coe, PhD and PEDAL lab affiliate Lindsay White, PhD. 

Dr. Oney and colleagues estimated the out-of-pocket costs associated with Alzheimer’s disease and related dementias (ADRDs), which results from a gap in insurance coverage for ADRD-related services. Because Medicare does not cover most long-term care services, those in need must pay out-of-pocket until their wealth and assets have been sufficiently depleted. After their wealth and assets have depleted, Medicaid will kick in. This study highlights the burden of cost associated with this gap.

Dr. Oney worked with data from the Health and Retirement (HRS) study from 2000-2014. Using statistical modeling, Dr. Oney’s results showed that people with dementia are paying $7,500 out-of-pocket over the first 8 years after dementia diagnosis. To put that in perspective, that’s almost half of what Medicare pays. Nursing homes comprise the largest component of out-of-pocket spending, and are a major driver of gender and racial differences in out-of-pocket spending. 

Jordan Weiss, a PhD Candidate in Demography and Sociology at the University of Pennsylvania and PEDAL Lab research affiliate presented on the “16-year risk of dementia under hypothetical interventions on its risk factors: An application of the parametric g-formula.” Jordan began his presentation by discussing the factors that contribute to trends in dementia, including level of education, management of hypertension, and cardiovascular risk factors. 

Jordan used data from the HRS combined with the parametric g-formula to model the time-varying relationships between education, comorbidities, and lifestyle characteristics, and to calculate dementia risk under different intervention scenarios. His results suggest that increasing levels of diabetes and obesity could lead to a rebound in the risk of dementia, especially considering that gains in educational attainment and improvements in cardiovascular disease symptomology face leveling off effects.

Jordan also received the Laurence G. Branch Doctoral Student Research Award. This award honors outstanding students for exceptional research. Jordan is currently on the job market.

Lindsay White, MPH, PhD, a Research Public Health Analyst at RTI International and PEDAL Lab research affiliate, presented on “Socioeconomic disparities in the timely diagnosis of dementia.” She completed this research with PEDAL lab Director Dr. Coe and PEDAL Lab affiliate Paul Fishman, PhD, MA.

Dr. White began her presentation by discussing how the diagnosis of dementia can be difficult and dementia is frequently unrecognized by health care providers. She shared information on the benefits of a timely diagnosis of dementia including how many pharmacological and non-pharmacological interventions are most effective when administered early in the disease trajectory. 

Dr. White used data from the HRS and Medicare claims to identify factors associated with a timely diagnosis of incident dementia and a timely diagnosis of incident cognitive impairment no dementia (CIND). 

Dr. White’s results showed that race and educational attainment were independently associated with the odds of receiving a timely diagnosis of dementia and a timely diagnosis of CIND. Non-Hispanic black respondents were significantly less likely than non-Hispanic white respondents to receive a timely diagnosis of either condition. Compared to respondents with a college degree, respondents with lower educational attainment were significantly less likely to receive a timely diagnosis of either dementia or CIND. Finally, respondents who were living alone were significantly less likely to receive a timely diagnosis of dementia in comparison to respondents who were living with others. 

Policy implications of this work include targeted screening approaches aimed at racial/ethnic minorities, individuals with lower educational attainment, and older individuals living alone.