Similarities and differences in Alzheimer's dementia comorbidities in racialized populations identified from electronic medical records.

ABSTRACT

BACKGROUND: Alzheimer's dementia (AD) is a neurodegenerative disease that is disproportionately prevalent in racially marginalized individuals. However, due to research underrepresentation, the spectrum of AD-associated comorbidities that increase AD risk or suggest AD treatment disparities in these individuals is not completely understood. We leveraged electronic medical records (EMR) to explore AD-associated comorbidities and disease networks in racialized individuals identified as Asian, Non-Latine Black, Latine, or Non-Latine White. METHODS: We performed low-dimensional embedding, differential analysis, and disease network-based analyses of 5664 patients with AD and 11,328 demographically matched controls across two EMR systems and five medical centers, with equal representation of Asian-, Non-Latine Black-, Latine-, and Non-Latine White-identified individuals. For low-dimensional embedding and disease network comparisons, Mann-Whitney U tests or Kruskal-Wallis tests followed by Dunn's tests were used to compare categories. Fisher's exact or chi-squared tests were used for differential analysis. Spearman's rank correlation coefficients were used to compare results between the two EMR systems. RESULTS: Here we show that primarily established AD-associated comorbidities, such as essential hypertension and major depressive disorder, are generally similar across racialized populations. However, a few comorbidities, including respiratory diseases, may be significantly associated with AD in Black- and Latine- identified individuals. CONCLUSIONS: Our study revealed similarities and differences in AD-associated comorbidities and disease networks between racialized populations. Our approach could be a starting point for hypothesis-driven studies that can further explore the relationship between these comorbidities and AD in racialized populations, potentially identifying interventions that can reduce AD health disparities.

Black- and Latine- identified individuals in the United States are more likely to have Alzheimer's dementia (AD) relative to Asian- and White- identified individuals. Despite this, Black- and Latine- identified individuals are less likely to be included in studies that attempt to understand and treat AD. Patients' medical information, electronically recorded by healthcare providers, was used to explore whether patients with AD were more likely to have different conditions relative to patients who do not have AD. We did this analysis separately for Asian-, Non-Latine Black-, Latine- and Non-Latine White- identified individuals for a total of four analyses. While we found many conditions that were shared by all individuals, a few, such as lung-related diseases, may be more common in specific identified race and ethnicity categories.