# Racial Disparities in Delayed Dementia Diagnosis: Structural Determinants and Validation of Timeliness Measures

> **NIH NIH K99** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2022 · $124,200

## Abstract

PROJECT SUMMARY
The number of people impacted by Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (ADRD)
is 5 million in the US alone and is expected to grow, especially in Black communities. Black older adults have a
40-80% higher incidence of ADRD and approximately double the risk of underdiagnosis. Innovative use of
survey-Medicare Claims linked data holds promise to advance our understanding of disparities in timely ADRD
diagnosis and their contributing factors. However, no prior research has validated this approach. Also, prior
research on risk factors for delayed ADRD diagnosis has focused on individual-level characteristics that are
difficult to modify. I seek to fill this gap by validating the measure of timeliness of ADRD diagnosis with respect
to the survival benefits and examining placed-based structural factors associated with disparities in timely
ADRD diagnosis. Residential racial segregation and geographic features of health care access are important to
consider together. While unequal distribution of health care resources in segregated areas may be the primary
driver of the racial disparities in timely diagnosis, residential segregation may capture unobserved features of
structural racism influencing health care utilization patterns by race. These factors can be mutually reinforcing
drivers of poor diagnosis in the Black population. In the K99 phase, I will conduct a robust epidemiological
analysis to examine the timeliness of ADRD diagnosis related to survival using the Health and Retirement
Study and the National Health and Aging Trends Study. In the R00 phase, I will examine the association
between residential racial segregation or health care access features and racial disparities in the timeliness of
ADRD diagnosis while extending my inquiry to the cohort from the Reasons for Geographic and Racial
Disparities in Stroke study. I will also examine how the magnitude of the association between health service
characteristics and timely ADRD diagnosis differs by small-area characteristics (e.g., area deprivation) and
individual characteristics (e.g., education). This research plan is complemented by a training plan that builds on
my background in social work and sociology, and includes new training in (1) neurodegenerative diseases,
clinical assessment, and diagnostic pathways; (2) application of algorithm-based dementia assessment in
surveys; (3) utilization of Medicare claims data, and (4) gaining additional sociological knowledge in linking
data in residential segregation, health care access, and racial disparities related to timely ADRD diagnosis.
The combined research and training plans will prepare me for a successful independent research career
focused on identifying modifiable determinants of Alzheimer’s disease and related dementias, and study of the
effects of policies and interventions to reduce racial disparities in ADRD. Together, these have the potential to
improve prevention and care in ADRD. My mentorsh...

## Key facts

- **NIH application ID:** 10506316
- **Project number:** 1K99AG078405-01
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Min Hee Kim
- **Activity code:** K99 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $124,200
- **Award type:** 1
- **Project period:** 2022-09-01 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10506316

## Citation

> US National Institutes of Health, RePORTER application 10506316, Racial Disparities in Delayed Dementia Diagnosis: Structural Determinants and Validation of Timeliness Measures (1K99AG078405-01). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10506316. Licensed CC0.

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