[
 {
  "metric": "Rate of missed or delayed clinical dementia diagnosis (claims-based)",
  "group_a": "Non-Hispanic Black adults 70+",
  "group_b": "Non-Hispanic White adults 70+",
  "value_a": 46,
  "value_b": 41,
  "unit": "percent",
  "ratio_or_difference": "+5 percentage points (46/41 = 1.12x)",
  "year": "Not specified precisely in source; Health and Retirement Study cohort, published 2021",
  "population": "3,966 US adults age 70+ with probable dementia, Health and Retirement Study linked to Medicare/Medicaid claims",
  "source_name": "Lin PJ et al., 'Dementia Diagnosis Disparities by Race and Ethnicity,' Medical Care (2021) — summarized by Tufts Center for the Evaluation of Value and Risk in Health (CEVR)",
  "source_url": "https://cevr.tuftsmedicalcenter.org/publications/dementia-diagnosis-disparities-by-race-and-ethnicity",
  "notes": "Diagnosis considered 'missed/delayed' if not captured in claims by the time of study-assessed probable dementia. Full peer-reviewed article behind paywall; figures verified via research center's public summary of the study."
 },
 {
  "metric": "Rate of missed or delayed clinical dementia diagnosis (claims-based)",
  "group_a": "Hispanic adults 70+",
  "group_b": "Non-Hispanic White adults 70+",
  "value_a": 54,
  "value_b": 41,
  "unit": "percent",
  "ratio_or_difference": "+13 percentage points (54/41 = 1.32x)",
  "year": "Not specified precisely in source; Health and Retirement Study cohort, published 2021",
  "population": "3,966 US adults age 70+ with probable dementia, Health and Retirement Study linked to Medicare/Medicaid claims",
  "source_name": "Lin PJ et al., 'Dementia Diagnosis Disparities by Race and Ethnicity,' Medical Care (2021) — summarized by Tufts CEVR",
  "source_url": "https://cevr.tuftsmedicalcenter.org/publications/dementia-diagnosis-disparities-by-race-and-ethnicity",
  "notes": "Same study/cohort as Black-White comparison above. Full peer-reviewed article behind paywall; figures verified via research center's public summary."
 },
 {
  "metric": "Mean delay in dementia diagnosis after clinical onset",
  "group_a": "Non-Hispanic Black adults 70+ with a delayed diagnosis",
  "group_b": "Non-Hispanic White adults 70+ with a delayed diagnosis",
  "value_a": 34.6,
  "value_b": 31.2,
  "unit": "months",
  "ratio_or_difference": "+3.4 months (34.6/31.2 = 1.11x, i.e. ~11% longer, matching source's own reported figure)",
  "year": "Not specified precisely in source; Health and Retirement Study cohort, published 2021",
  "population": "Subset of 3,966 US adults age 70+ with probable dementia who experienced a delayed diagnosis, HRS linked to Medicare/Medicaid claims",
  "source_name": "Lin PJ et al., 'Dementia Diagnosis Disparities by Race and Ethnicity,' Medical Care (2021) — summarized by Tufts CEVR",
  "source_url": "https://cevr.tuftsmedicalcenter.org/publications/dementia-diagnosis-disparities-by-race-and-ethnicity",
  "notes": "Delay measured only among those with a missed/delayed diagnosis, not the full sample."
 },
 {
  "metric": "Mean delay in dementia diagnosis after clinical onset",
  "group_a": "Hispanic adults 70+ with a delayed diagnosis",
  "group_b": "Non-Hispanic White adults 70+ with a delayed diagnosis",
  "value_a": 43.8,
  "value_b": 31.2,
  "unit": "months",
  "ratio_or_difference": "+12.6 months (43.8/31.2 = 1.40x, i.e. ~40% longer, matching source's own reported figure)",
  "year": "Not specified precisely in source; Health and Retirement Study cohort, published 2021",
  "population": "Subset of 3,966 US adults age 70+ with probable dementia who experienced a delayed diagnosis, HRS linked to Medicare/Medicaid claims",
  "source_name": "Lin PJ et al., 'Dementia Diagnosis Disparities by Race and Ethnicity,' Medical Care (2021) — summarized by Tufts CEVR",
  "source_url": "https://cevr.tuftsmedicalcenter.org/publications/dementia-diagnosis-disparities-by-race-and-ethnicity",
  "notes": "Delay measured only among those with a missed/delayed diagnosis, not the full sample."
 },
 {
  "metric": "Rate of MRI testing for cognitive impairment workup",
  "group_a": "Black patients",
  "group_b": "White patients",
  "value_a": 50.9,
  "value_b": 60,
  "unit": "percent",
  "ratio_or_difference": "-9.1 percentage points (50.9/60 = 0.85x, i.e. Black patients tested at ~85% of the White rate)",
  "year": "Not specified in press release; 4-year retrospective period",
  "population": "Outpatients undergoing imaging for cognitive impairment at Boston Medical Center, a safety-net academic medical center",
  "source_name": "RSNA press release, 'Black Patients Face Delays in Alzheimer's Diagnosis'",
  "source_url": "https://www.rsna.org/media/press/i/2480",
  "notes": "Hispanic patients had the highest MRI testing rate (67%) among groups reported; press release did not give the underlying sample size or exact study years."
 },
 {
  "metric": "Average age at first brain imaging (CT/MRI) for cognitive impairment",
  "group_a": "Black patients",
  "group_b": "White patients",
  "value_a": 72.5,
  "value_b": 67.8,
  "unit": "years",
  "ratio_or_difference": "+4.7 years (72.5/67.8 = 1.07x)",
  "year": "Not specified in press release; 4-year retrospective period",
  "population": "Outpatients undergoing imaging for cognitive impairment at Boston Medical Center, a safety-net academic medical center",
  "source_name": "RSNA press release, 'Black Patients Face Delays in Alzheimer's Diagnosis'",
  "source_url": "https://www.rsna.org/media/press/i/2480",
  "notes": "Reflects later presentation for imaging workup among Black patients relative to White and Hispanic (66.5 years) patients."
 },
 {
  "metric": "Representation in dementia clinical trials vs. share of US population",
  "group_a": "Black/African American share of dementia clinical trial participants (2000-2019)",
  "group_b": "Black/African American share of total US population (2023)",
  "value_a": 6.1,
  "value_b": 14.4,
  "unit": "percent",
  "ratio_or_difference": "0.42x (6.1/14.4); Black Americans are represented in trials at less than half their population share",
  "year": "2000-2019 (trials); 2023 (population estimate)",
  "population": "12,900 participant records across 96 dementia clinical trials registered on ClinicalTrials.gov (US, UK, Canada) reporting ethnicity data",
  "source_name": "Racial and Ethnic Representation in Dementia Clinical Trials Registered on ClinicalTrials.gov (US/UK/Canada); population share from Pew Research Center",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13156897/",
  "notes": "Trial dataset spans US, UK, and Canada, not US-only, so comparison to US population share is approximate. US Black population share (14.4% in 2023) verified separately at pewresearch.org/race-and-ethnicity/fact-sheet/facts-about-the-us-black-population/."
 },
 {
  "metric": "Representation in dementia clinical trials vs. share of US population",
  "group_a": "Hispanic/Latino share of dementia clinical trial participants (2000-2019)",
  "group_b": "Hispanic/Latino share of total US population (2024)",
  "value_a": 2.2,
  "value_b": 20,
  "unit": "percent",
  "ratio_or_difference": "0.11x (2.2/20); Hispanic Americans are represented in trials at about one-ninth their population share",
  "year": "2000-2019 (trials); 2024 (population estimate)",
  "population": "12,900 participant records across 96 dementia clinical trials registered on ClinicalTrials.gov (US, UK, Canada) reporting ethnicity data",
  "source_name": "Racial and Ethnic Representation in Dementia Clinical Trials Registered on ClinicalTrials.gov (US/UK/Canada); population share from Pew Research Center",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13156897/",
  "notes": "Trial dataset spans US, UK, and Canada, not US-only. US Hispanic population share (20% in 2024) verified separately at pewresearch.org/short-reads/2025/10/22/key-facts-about-us-latinos/."
 },
 {
  "metric": "Trial eligibility funnel: share of screened vs. enrolled participants who were Black",
  "group_a": "Non-Hispanic Black share of screened participants",
  "group_b": "Non-Hispanic Black share of enrolled/randomized participants",
  "value_a": 7,
  "value_b": 3,
  "unit": "percent",
  "ratio_or_difference": "Enrolled share is 0.43x the screened share (3/7); a disproportionate drop-off at the eligibility stage",
  "year": "Not specified; Phase 2/3 lecanemab and elenbecestat trials (pre-2023)",
  "population": "10,648 screened / 2,444 randomized participants across Phase 2 and Phase 3 lecanemab and elenbecestat trials in early Alzheimer's disease",
  "source_name": "Eligibility rates among racially and ethnically diverse US participants in Phase 2/3 lecanemab and elenbecestat trials",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11733864/",
  "notes": "Study found non-Hispanic Black participants were more likely than non-Hispanic White participants to be ruled ineligible (OR=3.75), largely due to amyloid biomarker eligibility criteria."
 },
 {
  "metric": "Trial eligibility funnel: share of screened vs. enrolled participants who were Hispanic White",
  "group_a": "Hispanic White share of screened participants",
  "group_b": "Hispanic White share of enrolled/randomized participants",
  "value_a": 25,
  "value_b": 17,
  "unit": "percent",
  "ratio_or_difference": "Enrolled share is 0.68x the screened share (17/25)",
  "year": "Not specified; Phase 2/3 lecanemab and elenbecestat trials (pre-2023)",
  "population": "10,648 screened / 2,444 randomized participants across Phase 2 and Phase 3 lecanemab and elenbecestat trials in early Alzheimer's disease",
  "source_name": "Eligibility rates among racially and ethnically diverse US participants in Phase 2/3 lecanemab and elenbecestat trials",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11733864/",
  "notes": "Hispanic White participants had higher odds of ineligibility than non-Hispanic White participants (OR=4.15), primarily via amyloid biomarker screen-fail."
 },
 {
  "metric": "Hispanic/Latino representation in dementia clinical trials over time",
  "group_a": "Hispanic/Latino share of trial participants, 2016-2019",
  "group_b": "Hispanic/Latino share of trial participants, 2000-2015",
  "value_a": 0.68,
  "value_b": 2.15,
  "unit": "percent",
  "ratio_or_difference": "0.32x (0.68/2.15); a 68% relative decline despite improved ethnicity-reporting standards",
  "year": "2000-2015 vs. 2016-2019",
  "population": "12,900 participant records across 96 dementia clinical trials registered on ClinicalTrials.gov (US, UK, Canada) reporting ethnicity data",
  "source_name": "Racial and Ethnic Representation in Dementia Clinical Trials Registered on ClinicalTrials.gov (US/UK/Canada)",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13156897/",
  "notes": "100% of trials in the later period reported ethnicity data (vs. incomplete reporting earlier), so the decline reflects actual composition change, not just better reporting."
 },
 {
  "metric": "Asian representation in dementia clinical trials over time",
  "group_a": "Asian share of trial participants, 2016-2019",
  "group_b": "Asian share of trial participants, 2000-2015",
  "value_a": 1.24,
  "value_b": 4.86,
  "unit": "percent",
  "ratio_or_difference": "0.26x (1.24/4.86); a ~75% relative decline",
  "year": "2000-2015 vs. 2016-2019",
  "population": "12,900 participant records across 96 dementia clinical trials registered on ClinicalTrials.gov (US, UK, Canada) reporting ethnicity data",
  "source_name": "Racial and Ethnic Representation in Dementia Clinical Trials Registered on ClinicalTrials.gov (US/UK/Canada)",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13156897/",
  "notes": "Reported alongside the Hispanic/Latino decline in the same dataset; authors flag declining diversity as a growing concern for trial generalizability."
 },
 {
  "metric": "Weekly hours of unpaid informal caregiving for a person with dementia",
  "group_a": "Hispanic caregivers",
  "group_b": "White caregivers",
  "value_a": 35.8,
  "value_b": 20.1,
  "unit": "hours per week",
  "ratio_or_difference": "1.78x (35.8/20.1)",
  "year": "2002-2018",
  "population": "10,015 community-dwelling US adults 70+ with dementia (modified Hurd algorithm), Health and Retirement Study",
  "source_name": "Cantu et al., 'Racial and Ethnic Disparities in the Monetary Value of Informal Caregiving for Non-Institutionalized People Living With Dementia,' Journal of Aging and Health (2024)",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11363470/",
  "notes": "Unadjusted hours; care recipient (not caregiver) race/ethnicity used to define groups per the source's framing."
 },
 {
  "metric": "Weekly hours of unpaid informal caregiving for a person with dementia",
  "group_a": "Black caregivers",
  "group_b": "White caregivers",
  "value_a": 30.1,
  "value_b": 20.1,
  "unit": "hours per week",
  "ratio_or_difference": "1.50x (30.1/20.1)",
  "year": "2002-2018",
  "population": "10,015 community-dwelling US adults 70+ with dementia (modified Hurd algorithm), Health and Retirement Study",
  "source_name": "Cantu et al., 'Racial and Ethnic Disparities in the Monetary Value of Informal Caregiving for Non-Institutionalized People Living With Dementia,' Journal of Aging and Health (2024)",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11363470/",
  "notes": "Unadjusted hours; care recipient (not caregiver) race/ethnicity used to define groups per the source's framing."
 },
 {
  "metric": "Annual monetary value of informal (unpaid) dementia caregiving, replacement-cost method",
  "group_a": "Hispanic care recipients",
  "group_b": "White care recipients",
  "value_a": 44656,
  "value_b": 25121,
  "unit": "USD per year (2018 dollars)",
  "ratio_or_difference": "1.78x (44656/25121)",
  "year": "2002-2018",
  "population": "10,015 community-dwelling US adults 70+ with dementia, Health and Retirement Study",
  "source_name": "Cantu et al., Journal of Aging and Health (2024)",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11363470/",
  "notes": "Valued at $24/hour replacement cost (2018 USD); mirrors the hours-per-week disparity above."
 },
 {
  "metric": "Annual monetary value of informal (unpaid) dementia caregiving, replacement-cost method",
  "group_a": "Black care recipients",
  "group_b": "White care recipients",
  "value_a": 37508,
  "value_b": 25121,
  "unit": "USD per year (2018 dollars)",
  "ratio_or_difference": "1.49x (37508/25121)",
  "year": "2002-2018",
  "population": "10,015 community-dwelling US adults 70+ with dementia, Health and Retirement Study",
  "source_name": "Cantu et al., Journal of Aging and Health (2024)",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11363470/",
  "notes": "Valued at $24/hour replacement cost (2018 USD); mirrors the hours-per-week disparity above."
 },
 {
  "metric": "Depressive disorder onset rate among high-intensity (>=40 hrs/week) family caregivers",
  "group_a": "Non-Hispanic White caregivers",
  "group_b": "Non-Hispanic Black caregivers",
  "value_a": 27.1,
  "value_b": 18.1,
  "unit": "percent",
  "ratio_or_difference": "+9.0 percentage points (27.1/18.1 = 1.50x)",
  "year": "Not specified precisely in fetched excerpt",
  "population": "Family caregivers of persons with dementia; Health and Retirement Study-based cohort",
  "source_name": "'Caregiving intensity and duration, cardiovascular disease, and race/ethnicity in family caregivers of persons with dementia'",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10990827/",
  "notes": "Only the White subgroup showed a statistically significant increase in depression with higher caregiving intensity (p=.0244); Black and Hispanic subgroup differences were not statistically significant, and overall race x intensity interaction was not significant (p=.3805). Small subgroup sample sizes widen the Black/Hispanic confidence intervals."
 },
 {
  "metric": "Depressive disorder onset rate among low-intensity (<=8 hrs/week) family caregivers",
  "group_a": "Hispanic caregivers",
  "group_b": "Non-Hispanic White caregivers",
  "value_a": 31.5,
  "value_b": 22.6,
  "unit": "percent",
  "ratio_or_difference": "+8.9 percentage points (31.5/22.6 = 1.39x)",
  "year": "Not specified precisely in fetched excerpt",
  "population": "Family caregivers of persons with dementia; Health and Retirement Study-based cohort",
  "source_name": "'Caregiving intensity and duration, cardiovascular disease, and race/ethnicity in family caregivers of persons with dementia'",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10990827/",
  "notes": "Hispanic caregiver subgroup difference between low- and high-intensity caregiving was not statistically significant; wide confidence intervals due to smaller subgroup size."
 },
 {
  "metric": "Probable dementia prevalence among Medicare beneficiaries",
  "group_a": "Non-Hispanic Black beneficiaries",
  "group_b": "Non-Hispanic White beneficiaries",
  "value_a": 10,
  "value_b": 5,
  "unit": "percent",
  "ratio_or_difference": "2.0x (10/5)",
  "year": "2015",
  "population": "National Health and Aging Trends Study (NHATS), 2015 round, Medicare beneficiaries",
  "source_name": "'Prevalence of Dementia in American Indians and Alaska Natives Compared to White, Black, and Hispanic Medicare Beneficiaries: Findings from NHATS'",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10184505/",
  "notes": "95% CI for Non-Hispanic Black estimate: 8%-11%; for Non-Hispanic White: 4%-6%."
 },
 {
  "metric": "Probable dementia prevalence among Medicare beneficiaries",
  "group_a": "Hispanic beneficiaries",
  "group_b": "Non-Hispanic White beneficiaries",
  "value_a": 13,
  "value_b": 5,
  "unit": "percent",
  "ratio_or_difference": "2.6x (13/5)",
  "year": "2015",
  "population": "National Health and Aging Trends Study (NHATS), 2015 round, Medicare beneficiaries",
  "source_name": "'Prevalence of Dementia in American Indians and Alaska Natives Compared to White, Black, and Hispanic Medicare Beneficiaries: Findings from NHATS'",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10184505/",
  "notes": "95% CI for Hispanic estimate: 10%-17%; for Non-Hispanic White: 4%-6%."
 },
 {
  "metric": "Probable dementia prevalence among Medicare beneficiaries",
  "group_a": "American Indian/Alaska Native beneficiaries",
  "group_b": "Non-Hispanic White beneficiaries",
  "value_a": 9,
  "value_b": 5,
  "unit": "percent",
  "ratio_or_difference": "1.8x (9/5)",
  "year": "2015",
  "population": "National Health and Aging Trends Study (NHATS), 2015 round, Medicare beneficiaries",
  "source_name": "'Prevalence of Dementia in American Indians and Alaska Natives Compared to White, Black, and Hispanic Medicare Beneficiaries: Findings from NHATS'",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10184505/",
  "notes": "95% CI for AIAN estimate is very wide (1%-16%) due to a small unweighted AIAN sample (n=68); interpret with caution. For Non-Hispanic White: 4%-6%."
 },
 {
  "metric": "Age-adjusted Alzheimer disease death rate, men aged 65+",
  "group_a": "Non-Hispanic White men",
  "group_b": "Non-Hispanic Black men",
  "value_a": 201.7,
  "value_b": 176.8,
  "unit": "deaths per 100,000",
  "ratio_or_difference": "1.14x (201.7/176.8); White men had the higher rate among men",
  "year": "2018",
  "population": "US adults aged 65+, National Vital Statistics System",
  "source_name": "CDC MMWR QuickStats: Age-Adjusted Death Rates for Alzheimer Disease Among Adults Aged >=65, by Sex and Race/Hispanic Origin, NVSS 2018",
  "source_url": "https://www.cdc.gov/mmwr/volumes/69/wr/mm6944a7.htm",
  "notes": "Women had higher AD death rates than men within all three race/Hispanic-origin groups (see related sex-difference entries)."
 },
 {
  "metric": "Age-adjusted Alzheimer disease death rate, men aged 65+",
  "group_a": "Non-Hispanic White men",
  "group_b": "Hispanic men",
  "value_a": 201.7,
  "value_b": 168.4,
  "unit": "deaths per 100,000",
  "ratio_or_difference": "1.20x (201.7/168.4)",
  "year": "2018",
  "population": "US adults aged 65+, National Vital Statistics System",
  "source_name": "CDC MMWR QuickStats, NVSS 2018",
  "source_url": "https://www.cdc.gov/mmwr/volumes/69/wr/mm6944a7.htm",
  "notes": "CDC notes Hispanic-origin death rates should be interpreted with some caution due to reporting inconsistencies on death certificates."
 },
 {
  "metric": "Age-adjusted Alzheimer disease death rate, women aged 65+",
  "group_a": "Non-Hispanic White women",
  "group_b": "Non-Hispanic Black women",
  "value_a": 285.1,
  "value_b": 234.7,
  "unit": "deaths per 100,000",
  "ratio_or_difference": "1.21x (285.1/234.7)",
  "year": "2018",
  "population": "US adults aged 65+, National Vital Statistics System",
  "source_name": "CDC MMWR QuickStats, NVSS 2018",
  "source_url": "https://www.cdc.gov/mmwr/volumes/69/wr/mm6944a7.htm",
  "notes": "Part of the same CDC dataset as the men's comparisons above."
 },
 {
  "metric": "Age-adjusted Alzheimer disease death rate, women aged 65+",
  "group_a": "Non-Hispanic White women",
  "group_b": "Hispanic women",
  "value_a": 285.1,
  "value_b": 218.8,
  "unit": "deaths per 100,000",
  "ratio_or_difference": "1.30x (285.1/218.8)",
  "year": "2018",
  "population": "US adults aged 65+, National Vital Statistics System",
  "source_name": "CDC MMWR QuickStats, NVSS 2018",
  "source_url": "https://www.cdc.gov/mmwr/volumes/69/wr/mm6944a7.htm",
  "notes": "CDC notes Hispanic-origin death rates should be interpreted with some caution due to reporting inconsistencies."
 },
 {
  "metric": "Share of dementia cases attributable to modifiable risk factors",
  "group_a": "Latino participants",
  "group_b": "White participants",
  "value_a": 33,
  "value_b": 22,
  "unit": "percent",
  "ratio_or_difference": "+11 percentage points (33/22 = 1.5x)",
  "year": "2024 (Multiethnic Cohort Study analysis, as cited in 2025 Alzheimer's Disease Facts and Figures)",
  "population": "Multiethnic Cohort Study participants (Latino, Native Hawaiian, African American, White, Japanese American)",
  "source_name": "Alzheimer's Association, 2025 Alzheimer's Disease Facts and Figures Report, citing Multiethnic Cohort Study",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12040760/",
  "notes": "Higher attributable fraction indicates greater theoretical potential for dementia prevention via risk-factor modification in that group, given current risk-factor prevalence and effect sizes in the model; it is a population-attributable-fraction estimate, not a direct prevalence or incidence measure."
 },
 {
  "metric": "Share of dementia cases attributable to modifiable risk factors",
  "group_a": "African American participants",
  "group_b": "White participants",
  "value_a": 28,
  "value_b": 22,
  "unit": "percent",
  "ratio_or_difference": "+6 percentage points (28/22 = 1.27x)",
  "year": "2024 (Multiethnic Cohort Study analysis, as cited in 2025 Alzheimer's Disease Facts and Figures)",
  "population": "Multiethnic Cohort Study participants (Latino, Native Hawaiian, African American, White, Japanese American)",
  "source_name": "Alzheimer's Association, 2025 Alzheimer's Disease Facts and Figures Report, citing Multiethnic Cohort Study",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12040760/",
  "notes": "Population-attributable-fraction estimate, not a direct prevalence/incidence measure. Native Hawaiians (29%) and Japanese Americans (14%) were also reported but excluded here for brevity."
 },
 {
  "metric": "Age-adjusted Alzheimer's disease/related dementia (ADRD) mortality rate, rural vs. urban",
  "group_a": "Rural counties",
  "group_b": "Urban counties",
  "value_a": 95.2,
  "value_b": 76.5,
  "unit": "deaths per 100,000",
  "ratio_or_difference": "1.24x (95.2/76.5)",
  "year": "2010",
  "population": "US adults, CDC WONDER mortality database, rural-urban classification",
  "source_name": "'Rural-Urban Disparities in ADRD Mortality by Nurse Practitioner and Physician Assistant Practice Policies'",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12759922/",
  "notes": "Study also examines how state-level NP/PA scope-of-practice policy relates to the rural-urban gap; noncore rural counties showed the steepest mortality increases over time."
 },
 {
  "metric": "Age-adjusted Alzheimer's disease/related dementia (ADRD) mortality rate, rural vs. urban",
  "group_a": "Rural counties",
  "group_b": "Urban counties",
  "value_a": 123.4,
  "value_b": 98.7,
  "unit": "deaths per 100,000",
  "ratio_or_difference": "1.25x (123.4/98.7)",
  "year": "2020",
  "population": "US adults, CDC WONDER mortality database, rural-urban classification",
  "source_name": "'Rural-Urban Disparities in ADRD Mortality by Nurse Practitioner and Physician Assistant Practice Policies'",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12759922/",
  "notes": "The rural-urban gap widened in absolute terms (18.7 to 24.7 per 100,000) between 2010 and 2020 even though the percent gap stayed roughly stable (~24-25%). Also reported: 61.8% of rural dementia deaths occurred in nursing homes vs. 53.9% of urban deaths."
 },
 {
  "metric": "Estimated lifetime risk of developing Alzheimer's disease, from age 45",
  "group_a": "Women",
  "group_b": "Men",
  "value_a": 20,
  "value_b": 10,
  "unit": "percent (1 in 5 vs. 1 in 10)",
  "ratio_or_difference": "2.0x (20/10)",
  "year": "Current estimate as published in Alzheimer's Association materials (modeled projection, not a measured incidence rate)",
  "population": "US population, actuarial/modeled lifetime-risk projection",
  "source_name": "Alzheimer's Association, Facts and Figures",
  "source_url": "https://www.alz.org/alzheimers-dementia/facts-figures",
  "notes": "This is a MODELED lifetime-risk projection (accounting for competing mortality risk over remaining lifespan), not a measured prevalence or incidence rate. Widely cited but the underlying actuarial methodology/cohort is not detailed on this consumer-facing page."
 },
 {
  "metric": "Number of Americans age 65+ living with Alzheimer's, by sex",
  "group_a": "Women",
  "group_b": "Men",
  "value_a": 4.5,
  "value_b": 2.9,
  "unit": "millions of people",
  "ratio_or_difference": "1.55x (4.5/2.9); men's figure derived as 7.4 total minus 4.5 women = 2.9 million",
  "year": "Current estimate (Alzheimer's Association, 2025 cycle)",
  "population": "US adults age 65+ living with Alzheimer's dementia (estimated total 7.4 million)",
  "source_name": "Alzheimer's Association, 'Women and Alzheimer's'",
  "source_url": "https://www.alz.org/alzheimers-dementia/what-is-alzheimers/women-and-alzheimer-s",
  "notes": "Source states 'almost two-thirds' of the 7.4 million Americans 65+ with Alzheimer's are women (4.5 million); the 2.9 million male figure is a simple subtraction, not independently stated by the source."
 },
 {
  "metric": "Age-adjusted Alzheimer disease death rate, by sex",
  "group_a": "Women 65+",
  "group_b": "Men 65+",
  "value_a": 267.9,
  "value_b": 191.9,
  "unit": "deaths per 100,000",
  "ratio_or_difference": "1.40x (267.9/191.9)",
  "year": "2018",
  "population": "US adults aged 65+, National Vital Statistics System",
  "source_name": "CDC MMWR QuickStats, NVSS 2018",
  "source_url": "https://www.cdc.gov/mmwr/volumes/69/wr/mm6944a7.htm",
  "notes": "Women had the higher death rate within every race/Hispanic-origin subgroup reported in the same source."
 },
 {
  "metric": "Ratio of female to male live-in dementia caregivers",
  "group_a": "Female live-in caregivers",
  "group_b": "Male live-in caregivers",
  "value_a": 2.5,
  "value_b": 1,
  "unit": "ratio (female-to-male)",
  "ratio_or_difference": "2.5x as reported directly by the source",
  "year": "Current estimate (Alzheimer's Association)",
  "population": "US live-in family caregivers of people with Alzheimer's/dementia",
  "source_name": "Alzheimer's Association, 'Women and Alzheimer's'",
  "source_url": "https://www.alz.org/alzheimers-dementia/what-is-alzheimers/women-and-alzheimer-s",
  "notes": "Reported as a direct ratio rather than raw counts; source also states women are >60% of all Alzheimer's/dementia caregivers and over one-third of caregivers are daughters."
 },
 {
  "metric": "Early lecanemab uptake rate among Medicare beneficiaries with AD/MCI diagnosis",
  "group_a": "Non-Hispanic White beneficiaries",
  "group_b": "Black beneficiaries",
  "value_a": 0.23,
  "value_b": 0.04,
  "unit": "percent (uptake rate)",
  "ratio_or_difference": "5.75x (0.23/0.04)",
  "year": "July 2023 - March 2024",
  "population": "US Medicare fee-for-service beneficiaries with a diagnosis of mild cognitive impairment or Alzheimer's dementia; 1,725 total lecanemab users identified",
  "source_name": "'Disparities in Early Lecanemab Uptake Among US Medicare Beneficiaries'",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12082366/",
  "notes": "Uptake rate = users / eligible beneficiaries in each group. Of 1,725 total lecanemab users, 90.5% were non-Hispanic White, 1.2% Black, 2.0% Hispanic, 1.3% Asian/Pacific Islander. All disparities reported as statistically significant (P<.001)."
 },
 {
  "metric": "Early lecanemab uptake rate among Medicare beneficiaries with AD/MCI diagnosis",
  "group_a": "Non-Hispanic White beneficiaries",
  "group_b": "Hispanic beneficiaries",
  "value_a": 0.23,
  "value_b": 0.07,
  "unit": "percent (uptake rate)",
  "ratio_or_difference": "3.29x (0.23/0.07)",
  "year": "July 2023 - March 2024",
  "population": "US Medicare fee-for-service beneficiaries with a diagnosis of mild cognitive impairment or Alzheimer's dementia; 1,725 total lecanemab users identified",
  "source_name": "'Disparities in Early Lecanemab Uptake Among US Medicare Beneficiaries'",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12082366/",
  "notes": "Uptake rate = users / eligible beneficiaries in each group. All disparities reported as statistically significant (P<.001)."
 },
 {
  "metric": "Early lecanemab uptake rate among Medicare beneficiaries with AD/MCI diagnosis, by sex",
  "group_a": "Male beneficiaries",
  "group_b": "Female beneficiaries",
  "value_a": 0.27,
  "value_b": 0.17,
  "unit": "percent (uptake rate)",
  "ratio_or_difference": "1.59x (0.27/0.17)",
  "year": "July 2023 - March 2024",
  "population": "US Medicare fee-for-service beneficiaries with a diagnosis of mild cognitive impairment or Alzheimer's dementia; 1,725 total lecanemab users identified (48.5% male, 51.5% female)",
  "source_name": "'Disparities in Early Lecanemab Uptake Among US Medicare Beneficiaries'",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12082366/",
  "notes": "All disparities reported as statistically significant (P<.001)."
 },
 {
  "metric": "Early lecanemab uptake rate among Medicare beneficiaries with AD/MCI diagnosis, by geography",
  "group_a": "Urban residents",
  "group_b": "Rural residents",
  "value_a": 0.22,
  "value_b": 0.14,
  "unit": "percent (uptake rate)",
  "ratio_or_difference": "1.57x (0.22/0.14)",
  "year": "July 2023 - March 2024",
  "population": "US Medicare fee-for-service beneficiaries with a diagnosis of mild cognitive impairment or Alzheimer's dementia; 1,725 total lecanemab users identified (88.0% urban, 11.9% rural)",
  "source_name": "'Disparities in Early Lecanemab Uptake Among US Medicare Beneficiaries'",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12082366/",
  "notes": "All disparities reported as statistically significant (P<.001)."
 },
 {
  "metric": "Early lecanemab uptake rate among Medicare beneficiaries, by socioeconomic status",
  "group_a": "Socioeconomically advantaged beneficiaries",
  "group_b": "Socioeconomically disadvantaged beneficiaries",
  "value_a": 0.27,
  "value_b": 0.01,
  "unit": "percent (uptake rate)",
  "ratio_or_difference": "27x (0.27/0.01) — the largest disparity of any subgroup in this study",
  "year": "July 2023 - March 2024",
  "population": "US Medicare fee-for-service beneficiaries with a diagnosis of mild cognitive impairment or Alzheimer's dementia; 1,725 total lecanemab users identified (98.7% socioeconomically advantaged, 1.3% disadvantaged)",
  "source_name": "'Disparities in Early Lecanemab Uptake Among US Medicare Beneficiaries'",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12082366/",
  "notes": "Socioeconomic classification method not detailed in the fetched excerpt (likely an area-level index tied to beneficiary zip code). All disparities reported as statistically significant (P<.001)."
 },
 {
  "metric": "Amyloid-PET positivity rate among cognitively impaired trial-screening participants (a gatekeeping criterion for anti-amyloid drug eligibility)",
  "group_a": "Non-Hispanic participants",
  "group_b": "Hispanic participants",
  "value_a": 80,
  "value_b": 37,
  "unit": "percent",
  "ratio_or_difference": "2.16x (80/37)",
  "year": "TRAILBLAZER-ALZ 2 trial screening cohort (trial conducted pre-2023)",
  "population": "Cognitively impaired screening participants (sample size >2,000) in the donanemab TRAILBLAZER-ALZ 2 trial",
  "source_name": "ALZFORUM, 'Biomarkers Suggest Black and Hispanic People Less Likely to Have Amyloid'",
  "source_url": "https://www.alzforum.org/news/research-news/biomarkers-suggest-black-and-hispanic-people-less-likely-have-amyloid",
  "notes": "Secondary science-journalism source summarizing conference/study data; the underlying primary TRAILBLAZER-ALZ 2 publication was not independently re-verified for this exact figure. Because current anti-amyloid drugs (donanemab, lecanemab) require confirmed amyloid pathology, lower observed positivity in Hispanic screenees functions as an access barrier upstream of treatment, though some of the gap may reflect referral/screening bias rather than true biological prevalence differences (per the same article, PET-confirmation rates among those who reached scanning did not differ by group)."
 },
 {
  "metric": "Amyloid-PET positivity rate in a real-world memory-care population",
  "group_a": "Non-Hispanic White patients",
  "group_b": "Black and Hispanic patients (combined)",
  "value_a": 68,
  "value_b": 60,
  "unit": "percent",
  "ratio_or_difference": "1.13x (68/60)",
  "year": "New IDEAS study (~2021-2023 data collection)",
  "population": "4,845 scanned patients in the New IDEAS real-world memory-care study",
  "source_name": "ALZFORUM, 'Biomarkers Suggest Black and Hispanic People Less Likely to Have Amyloid'",
  "source_url": "https://www.alzforum.org/news/research-news/biomarkers-suggest-black-and-hispanic-people-less-likely-have-amyloid",
  "notes": "Secondary science-journalism source; Black and Hispanic figures were combined in the source's reporting rather than broken out separately. Same access-barrier caveat as the TRAILBLAZER-ALZ 2 entry above."
 },
 {
  "metric": "Out-of-pocket home care spending as a share of monthly income, by income level",
  "group_a": "Older adults with dementia, income below 100% of federal poverty line",
  "group_b": "Older adults with dementia, income 100-200% of federal poverty line",
  "value_a": 87,
  "value_b": 53,
  "unit": "percent of monthly income",
  "ratio_or_difference": "1.64x (87/53)",
  "year": "Not specified precisely in fetched excerpt (2018 FPL thresholds referenced)",
  "population": "Older US adults with dementia paying out-of-pocket for home care",
  "source_name": "'Paying for home care out-of-pocket is common and costly across the income spectrum among older adults'",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11736716/",
  "notes": "Lowest-income group faces a dramatically higher relative cost burden despite likely spending less in absolute dollar terms; 52% of all people paying out-of-pocket for home care had incomes below 200% FPL."
 },
 {
  "metric": "Out-of-pocket home care spending as a share of monthly income, dementia vs. no dementia",
  "group_a": "Older adults with dementia paying out-of-pocket for home care",
  "group_b": "Older adults without dementia paying out-of-pocket for home care",
  "value_a": 40,
  "value_b": 14,
  "unit": "percent of monthly income (median)",
  "ratio_or_difference": "2.86x (40/14)",
  "year": "Not specified precisely in fetched excerpt",
  "population": "Older US adults paying out-of-pocket for home care",
  "source_name": "'Paying for home care out-of-pocket is common and costly across the income spectrum among older adults'",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11736716/",
  "notes": "This comparison is by dementia status rather than by income group, included here because it directly quantifies the disproportionate cost burden dementia places on affected households within the same cost-burden dataset used for the income-bracket entry above."
 },
 {
  "metric": "Mean annual out-of-pocket cost for people with dementia, by insurance type",
  "group_a": "Traditional Medicare enrollees",
  "group_b": "Medicaid (dual-eligible) enrollees",
  "value_a": 4590,
  "value_b": 2900,
  "unit": "USD per year",
  "ratio_or_difference": "1.58x (4590/2900)",
  "year": "2002-2022 (pooled study period)",
  "population": "72,758 people with dementia (mean age 75.7), Medicare Current Beneficiary Survey",
  "source_name": "'Out of Pocket Costs for People with Dementia: A Comparison Across Insurance Types'",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12759799/",
  "notes": "Medicaid enrollees have lower average total out-of-pocket spending than Traditional Medicare enrollees, but this reflects Medicaid's wraparound coverage for a population that is by definition low-income; a larger share of Medicaid recipients' out-of-pocket spending (60%) goes to nursing home/assisted living costs than for Traditional Medicare (33%) or Medicare Advantage (30%) enrollees."
 },
 {
  "metric": "Mean annual out-of-pocket cost for people with dementia, by insurance type",
  "group_a": "Traditional Medicare enrollees",
  "group_b": "Medicare Advantage enrollees",
  "value_a": 4590,
  "value_b": 2990,
  "unit": "USD per year",
  "ratio_or_difference": "1.54x (4590/2990)",
  "year": "2002-2022 (pooled study period)",
  "population": "72,758 people with dementia (mean age 75.7), Medicare Current Beneficiary Survey",
  "source_name": "'Out of Pocket Costs for People with Dementia: A Comparison Across Insurance Types'",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12759799/",
  "notes": "Medicare Advantage plans' supplemental benefits appear to lower average out-of-pocket costs relative to Traditional Medicare in this dataset."
 },
 {
  "metric": "Mean annual out-of-pocket dementia care cost for Medicaid (dual-eligible) enrollees, over time",
  "group_a": "2022",
  "group_b": "2002",
  "value_a": 14260,
  "value_b": 10950,
  "unit": "USD per year",
  "ratio_or_difference": "1.30x (14260/10950)",
  "year": "2002 vs. 2022",
  "population": "Medicaid-enrolled people with dementia, Medicare Current Beneficiary Survey",
  "source_name": "'Out of Pocket Costs for People with Dementia: A Comparison Across Insurance Types'",
  "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12759799/",
  "notes": "Rising Medicaid out-of-pocket costs occurred despite declining nursing-home utilization over the same period, suggesting cost growth in other categories (e.g., assisted living, home care) for this low-income, dual-eligible population."
 },
 {
  "metric": "Dementia incidence rate (health-plan diagnoses), age 64+",
  "group_a": "African American members",
  "group_b": "White members",
  "value_a": 26.6,
  "value_b": 19.3,
  "unit": "cases per 1,000 person-years",
  "ratio_or_difference": "1.38x (26.6/19.3); +7.3 per 1,000 person-years",
  "year": "2000-2013 (published 2016)",
  "population": "274,283 Kaiser Permanente Northern California members aged 64+ followed 2000-2013 (18,778 African American; 4,543 American Indian/Alaska Native; 21,000 Latino; 440 Pacific Islander; 206,490 White; 23,032 Asian American); 59,555 incident dementia diagnoses",
  "source_name": "Mayeda ER, Glymour MM, Quesenberry CP, Whitmer RA. Inequalities in dementia incidence between six racial and ethnic groups over 14 years. Alzheimers Dement 2016;12(3):216-224",
  "source_url": "https://doi.org/10.1016/j.jalz.2015.12.007",
  "notes": "PMID 26874595; PMC4969071. MEASURED crude incidence rates from the abstract. Cox models adjusted for age, sex, medical utilization and comorbidities gave HR 1.65 (95% CI 1.58-1.72) for African Americans vs Asian Americans (the lowest-incidence group), not vs Whites. Single integrated health system in one region; diagnoses are clinical, not research-adjudicated."
 },
 {
  "metric": "Dementia incidence rate (health-plan diagnoses), age 64+",
  "group_a": "American Indian/Alaska Native members",
  "group_b": "White members",
  "value_a": 22.2,
  "value_b": 19.3,
  "unit": "cases per 1,000 person-years",
  "ratio_or_difference": "1.15x (22.2/19.3); +2.9 per 1,000 person-years",
  "year": "2000-2013 (published 2016)",
  "population": "274,283 Kaiser Permanente Northern California members aged 64+ followed 2000-2013 (18,778 African American; 4,543 American Indian/Alaska Native; 21,000 Latino; 440 Pacific Islander; 206,490 White; 23,032 Asian American); 59,555 incident dementia diagnoses",
  "source_name": "Mayeda ER, Glymour MM, Quesenberry CP, Whitmer RA. Inequalities in dementia incidence between six racial and ethnic groups over 14 years. Alzheimers Dement 2016;12(3):216-224",
  "source_url": "https://doi.org/10.1016/j.jalz.2015.12.007",
  "notes": "PMID 26874595; PMC4969071. MEASURED crude rates. AIAN sample small (4,543). Second-highest incidence of the six groups after African Americans."
 },
 {
  "metric": "Dementia incidence rate (health-plan diagnoses), age 64+",
  "group_a": "Asian American members",
  "group_b": "White members",
  "value_a": 15.2,
  "value_b": 19.3,
  "unit": "cases per 1,000 person-years",
  "ratio_or_difference": "0.79x (15.2/19.3); -4.1 per 1,000 person-years",
  "year": "2000-2013 (published 2016)",
  "population": "274,283 Kaiser Permanente Northern California members aged 64+ followed 2000-2013 (18,778 African American; 4,543 American Indian/Alaska Native; 21,000 Latino; 440 Pacific Islander; 206,490 White; 23,032 Asian American); 59,555 incident dementia diagnoses",
  "source_name": "Mayeda ER, Glymour MM, Quesenberry CP, Whitmer RA. Inequalities in dementia incidence between six racial and ethnic groups over 14 years. Alzheimers Dement 2016;12(3):216-224",
  "source_url": "https://doi.org/10.1016/j.jalz.2015.12.007",
  "notes": "PMID 26874595; PMC4969071. MEASURED crude rates; Asian Americans had the lowest incidence of six groups. Lower diagnosed incidence may partly reflect under-detection (see the Tsoy 2021 timely-diagnosis record showing Asian beneficiaries were least likely to be diagnosed at the MCI stage). Latino (19.6) and Pacific Islander (19.6) rates were close to White."
 },
 {
  "metric": "Estimated 25-year cumulative risk of dementia from age 65",
  "group_a": "African American members",
  "group_b": "White members",
  "value_a": 38,
  "value_b": 30,
  "unit": "percent",
  "ratio_or_difference": "+8 percentage points (38/30 = 1.27x)",
  "year": "2000-2013 (published 2016)",
  "population": "274,283 Kaiser Permanente Northern California members aged 64+ followed 2000-2013 (18,778 African American; 4,543 American Indian/Alaska Native; 21,000 Latino; 440 Pacific Islander; 206,490 White; 23,032 Asian American); 59,555 incident dementia diagnoses",
  "source_name": "Mayeda ER, Glymour MM, Quesenberry CP, Whitmer RA. Inequalities in dementia incidence between six racial and ethnic groups over 14 years. Alzheimers Dement 2016;12(3):216-224",
  "source_url": "https://doi.org/10.1016/j.jalz.2015.12.007",
  "notes": "PMID 26874595; PMC4969071. MODELLED cumulative risk (derived from observed incidence). Other groups: AIAN 35%, Latino 32%, Asian American 28%, Pacific Islander 25%."
 },
 {
  "metric": "Dementia incidence rate among Asian American subgroups, age 64+",
  "group_a": "Filipino American members",
  "group_b": "Chinese American members",
  "value_a": 17.3,
  "value_b": 13.7,
  "unit": "cases per 1,000 person-years",
  "ratio_or_difference": "1.26x (17.3/13.7); covariate-adjusted HR 1.20 (95% CI 1.11-1.31)",
  "year": "2000-2013 (published 2017)",
  "population": "Kaiser Permanente Northern California members aged 64+ without dementia on 1 Jan 2000: 8,384 Chinese, 4,478 Japanese, 6,210 Filipino, 197 South Asian, 206,490 White; mean follow-up 9.6 years",
  "source_name": "Mayeda ER, Glymour MM, Quesenberry CP, Whitmer RA. Heterogeneity in 14-year Dementia Incidence Between Asian American Subgroups. Alzheimer Dis Assoc Disord 2017;31(3):181-186",
  "source_url": "https://doi.org/10.1097/WAD.0000000000000189",
  "notes": "PMID 28406845; PMC5568954. MEASURED age-standardized rates. Japanese 14.8 (adjusted HR 1.08, 0.99-1.18) and South Asian 12.1 (HR 0.81, 0.53-1.25, small n) vs Chinese. Whites had higher rates than every Asian subgroup. Shows that 'Asian American' aggregates hide meaningful subgroup differences."
 },
 {
  "metric": "Median survival after dementia diagnosis",
  "group_a": "White members",
  "group_b": "Asian American members",
  "value_a": 3.1,
  "value_b": 4.4,
  "unit": "years",
  "ratio_or_difference": "-1.3 years for Whites (3.1 vs 4.4)",
  "year": "2000-2013 (published 2017)",
  "population": "59,494 Kaiser Permanente Northern California members aged 64+ diagnosed with dementia 2000-2013 (from a dementia-free cohort of 23,032 Asian American, 18,778 African American, 21,000 Latino, 4,543 AIAN, 206,490 White)",
  "source_name": "Mayeda ER, Glymour MM, Quesenberry CP, Johnson JK, Perez-Stable EJ, Whitmer RA. Survival after dementia diagnosis in five racial/ethnic groups. Alzheimers Dement 2017;13(7):761-769",
  "source_url": "https://doi.org/10.1016/j.jalz.2016.12.008",
  "notes": "PMID 28174069; PMC5496783. MEASURED Kaplan-Meier medians: White 3.1, AIAN 3.4, African American 3.7, Latino 4.1, Asian American 4.4 years. Longer survival among minoritized groups persisted after comorbidity adjustment and mostly paralleled mortality differences in people without dementia; longer survival also means more years of care and cost."
 },
 {
  "metric": "Odds of a timely dementia diagnosis (incident diagnosis at MCI stage rather than dementia stage)",
  "group_a": "Asian Medicare beneficiaries",
  "group_b": "White Medicare beneficiaries (reference)",
  "value_a": 0.46,
  "value_b": 1.0,
  "unit": "adjusted odds ratio (White = 1.0)",
  "ratio_or_difference": "OR 0.46 (95% CI 0.38-0.56)",
  "year": "2015 incident diagnoses (claims 2013-2015; published 2021)",
  "population": "10,472 California fee-for-service Medicare beneficiaries with incident MCI or dementia diagnosis Jan-Jun 2015 (993 Asian, 407 Black, 1,255 Hispanic, 7,817 White); mean age 82.9",
  "source_name": "Tsoy E, Kiekhofer RE, Guterman EL, et al. Assessment of Racial/Ethnic Disparities in Timeliness and Comprehensiveness of Dementia Diagnosis in California. JAMA Neurol 2021;78(6):657-665",
  "source_url": "https://doi.org/10.1001/jamaneurol.2021.0399",
  "notes": "PMID 33779684; PMC8008426. MEASURED (claims-based, adjusted for age, sex, comorbidity, neighborhood disadvantage, rurality). Black OR 0.73 (0.56-0.94) and Hispanic OR 0.62 (0.52-0.72) were also less likely to receive a timely diagnosis. Asian beneficiaries also received fewer diagnostic-evaluation elements (specialist visit, labs, imaging): incidence rate ratio 0.81 (0.74-0.87). Only Asian, Black, Hispanic and White groups were included."
 },
 {
  "metric": "Odds of a timely diagnosis of cognitive impairment (initial diagnosis MCI rather than dementia)",
  "group_a": "Spanish-speaking patients",
  "group_b": "English-speaking patients (reference)",
  "value_a": 0.55,
  "value_b": 1.0,
  "unit": "adjusted odds ratio (English speakers = 1.0)",
  "ratio_or_difference": "adjusted OR 0.55 (95% CI 0.40-0.75); unadjusted OR 0.65 (0.53-0.80)",
  "year": "July 2017-June 2019 (published 2024)",
  "population": "12,080 English- or Spanish-speaking patients with an initial MCI or dementia diagnosis in the Yale New Haven Health electronic record",
  "source_name": "Silva-Rudberg JA, Carrion CI, Perez-Palmer N, et al. Assessment of disparities in timely diagnosis and comprehensive workup of cognitive impairment between English and Spanish speakers. Am J Geriatr Psychiatry 2024;32(7):773-786",
  "source_url": "https://doi.org/10.1016/j.jagp.2024.01.030",
  "notes": "PMID 38336573; PMC11162952. MEASURED, single health system. Adjusted for age, sex, ethnicity, neighborhood disadvantage and comorbidities. Within Hispanic/Latino patients, Spanish speakers vs English speakers: adjusted OR 0.53 (0.38-0.73), i.e., language preference rather than ethnicity predicted delayed diagnosis. Diagnostic services were otherwise provided equally, except more geriatrics referrals for Spanish speakers."
 },
 {
  "metric": "Odds of having undiagnosed dementia (probable dementia on study assessment but no Medicare-claims diagnosis)",
  "group_a": "Hispanic adults 65+",
  "group_b": "Non-Hispanic adults 65+ (reference)",
  "value_a": 2.48,
  "value_b": 1.0,
  "unit": "adjusted odds ratio (reference = 1.0)",
  "ratio_or_difference": "OR 2.48 (95% CI 1.19-5.14)",
  "year": "2011 (published 2018)",
  "population": "585 adults aged 65+ in the National Health and Aging Trends Study meeting criteria for probable dementia in 2011 with 3 years of continuous fee-for-service Medicare claims",
  "source_name": "Amjad H, Roth DL, Sheehan OC, Lyketsos CG, Wolff JL, Samus QM. Underdiagnosis of Dementia: an Observational Study of Patterns in Diagnosis and Awareness in US Older Adults. J Gen Intern Med 2018;33(7):1131-1138",
  "source_url": "https://doi.org/10.1007/s11606-018-4377-y",
  "notes": "PMID 29508259; PMC6025653. MEASURED. Overall 58.7% of older adults with probable dementia were undiagnosed (39.5%) or unaware of their diagnosis (19.2%). Less than high-school education (OR 0.54 for >=high school), attending medical visits alone (OR 1.98) and fewer functional impairments (OR 0.79 per impairment) also predicted being undiagnosed. Small Hispanic subgroup (wide CI)."
 },
 {
  "metric": "MCI detection rate (documented MCI diagnoses divided by model-expected MCI cases)",
  "group_a": "Black Medicare beneficiaries",
  "group_b": "Non-Hispanic White Medicare beneficiaries",
  "value_a": 0.039,
  "value_b": 0.098,
  "unit": "observed/expected ratio (1.0 = all expected cases diagnosed)",
  "ratio_or_difference": "0.40x (0.039/0.098)",
  "year": "2015-2019 (published 2023)",
  "population": "100% of Medicare fee-for-service and Medicare Advantage beneficiaries aged 65+ with near-continuous enrollment, 2015-2019; expected cases from a prediction model built on 2000-2016 Health and Retirement Study data",
  "source_name": "Mattke S, Jun H, Chen E, Liu Y, Becker A, Wallick C. Expected and diagnosed rates of mild cognitive impairment and dementia in the U.S. Medicare population: observational analysis. Alzheimers Res Ther 2023;15(1):128",
  "source_url": "https://doi.org/10.1186/s13195-023-01272-z",
  "notes": "PMID 37481563; PMC10362635. MODELLED denominator (expected cases predicted from HRS), MEASURED numerator (ICD-10 claims). Overall MCI detection rose from 0.062 (2015) to 0.079 (2019), leaving ~7.4 of 8 million expected MCI cases (92%) undiagnosed. Hispanic beneficiaries 0.048. Relevant to eligibility for anti-amyloid therapy, which requires early-stage diagnosis."
 },
 {
  "metric": "MCI detection rate (documented MCI diagnoses divided by model-expected MCI cases)",
  "group_a": "Dually eligible (Medicare + Medicaid) beneficiaries",
  "group_b": "Medicare-only beneficiaries",
  "value_a": 0.056,
  "value_b": 0.085,
  "unit": "observed/expected ratio (1.0 = all expected cases diagnosed)",
  "ratio_or_difference": "0.66x (0.056/0.085)",
  "year": "2015-2019 (published 2023)",
  "population": "100% of Medicare fee-for-service and Medicare Advantage beneficiaries aged 65+ with near-continuous enrollment, 2015-2019; expected cases from a prediction model built on 2000-2016 Health and Retirement Study data",
  "source_name": "Mattke S, Jun H, Chen E, Liu Y, Becker A, Wallick C. Expected and diagnosed rates of mild cognitive impairment and dementia in the U.S. Medicare population: observational analysis. Alzheimers Res Ther 2023;15(1):128",
  "source_url": "https://doi.org/10.1186/s13195-023-01272-z",
  "notes": "PMID 37481563; PMC10362635. MODELLED expected cases; MEASURED diagnoses. Dual eligibility is a proxy for low income."
 },
 {
  "metric": "Dementia detection ratio (documented dementia diagnoses divided by model-expected dementia cases)",
  "group_a": "Non-Hispanic White Medicare beneficiaries",
  "group_b": "Black Medicare beneficiaries",
  "value_a": 1.367,
  "value_b": 0.696,
  "unit": "observed/expected ratio (1.0 = diagnoses equal expected cases)",
  "ratio_or_difference": "1.96x (1.367/0.696)",
  "year": "2015-2019 (published 2023)",
  "population": "100% of Medicare fee-for-service and Medicare Advantage beneficiaries aged 65+ with near-continuous enrollment, 2015-2019; expected cases from a prediction model built on 2000-2016 Health and Retirement Study data",
  "source_name": "Mattke S, Jun H, Chen E, Liu Y, Becker A, Wallick C. Expected and diagnosed rates of mild cognitive impairment and dementia in the U.S. Medicare population: observational analysis. Alzheimers Res Ther 2023;15(1):128",
  "source_url": "https://doi.org/10.1186/s13195-023-01272-z",
  "notes": "PMID 37481563; PMC10362635. MODELLED expected cases. Dementia overall was diagnosed more often than expected (ratio 1.086-1.104), driven by non-Hispanic White beneficiaries (>1 may reflect over-coding or model under-prediction), while Black (0.696) and Hispanic (0.758) beneficiaries were under-diagnosed relative to expectation. Interpret ratios above 1 with caution."
 },
 {
  "metric": "Diagnosed dementia prevalence, adjusted for sociodemographic and health differences",
  "group_a": "Medicare Advantage beneficiaries",
  "group_b": "Traditional Medicare beneficiaries",
  "value_a": 7.1,
  "value_b": 8.7,
  "unit": "percent",
  "ratio_or_difference": "-1.6 percentage points (7.1/8.7 = 0.82x)",
  "year": "2017 (claims/encounter data 2015-2018; published 2023)",
  "population": "100% Medicare beneficiaries: Medicare Advantage encounter data and traditional Medicare claims",
  "source_name": "Haye S, Thunell J, Joyce G, et al. Estimates of diagnosed dementia prevalence and incidence among diverse beneficiaries in traditional Medicare and Medicare Advantage. Alzheimers Dement (Amst) 2023;15(3):e12472",
  "source_url": "https://doi.org/10.1002/dad2.12472",
  "notes": "PMID 37636488; PMC10450829. MEASURED diagnosed rates, adjusted comparison. Adjusted incidence also lower in MA (2.50% vs 2.99%). Lower MA rates held for men, women and White, Black, Hispanic, Asian and AIAN persons. Unadjusted 2017 MA incidence 2.54%, prevalence 7.04%; whole-Medicare prevalence 7.9%, incidence 2.8%. Authors warn lower diagnosis in MA 'may exacerbate racial/ethnic disparities'; MA risk adjustment for dementia began in 2020."
 },
 {
  "metric": "Incident dementia diagnosis rate among matched beneficiaries seen by the same primary care provider",
  "group_a": "Medicare Advantage beneficiaries",
  "group_b": "Traditional Medicare beneficiaries",
  "value_a": -0.11,
  "value_b": 0.0,
  "unit": "percentage-point difference in 2017 incident diagnosis rate (TM = 0 reference)",
  "ratio_or_difference": "-0.11 percentage points for MA vs TM with the same PCP",
  "year": "2017 (data 2016-2018; published 2025)",
  "population": "Propensity-score-matched sample of 15,410,030 Medicare beneficiaries with assigned PCPs in 2017; linear probability models with PCP fixed effects",
  "source_name": "Haye S, Jacobson M, Zissimopoulos J. Role of PCPs in diagnosing dementia in traditional Medicare and Medicare Advantage. Alzheimers Dement 2025;21(10):e14559",
  "source_url": "https://doi.org/10.1002/alz.14559",
  "notes": "PMID 41066196; PMC12510135. MEASURED difference; absolute base rates not in abstract, so value_b is the reference (0). MA patients were less likely to be seen by dementia specialists than TM patients of the same PCP, which the authors identify as a system-level contributor."
 },
 {
  "metric": "Receipt of guideline-recommended structural brain imaging (MRI or CT) within 365 days of a new cognitive-impairment diagnosis",
  "group_a": "Traditional Medicare, non-dual beneficiaries",
  "group_b": "Traditional Medicare, dually eligible (Medicaid) beneficiaries",
  "value_a": 60.5,
  "value_b": 57.9,
  "unit": "percent",
  "ratio_or_difference": "+2.6 percentage points",
  "year": "2021 diagnoses (data 2020-2022; published 2026)",
  "population": "1,095,947 community-dwelling Medicare beneficiaries aged 65-84 newly diagnosed with cognitive impairment in 2021 (373,561 MCI; 722,386 dementia), 100% TM and MA data",
  "source_name": "Mattke S, Liu Y, Ye W, Altunkaynak K. Structural brain imaging for newly diagnosed cognitive impairment by Medicare coverage type. J Am Coll Radiol 2026 (online)",
  "source_url": "https://doi.org/10.1016/j.jacr.2026.09.002",
  "notes": "PMID 42744196. MEASURED. Overall imaging rate 56.6% (65.9% after a dementia diagnosis, 50.5% after MCI). Medicare Advantage: 54.35% non-dual vs 52.7% dual. Initial scan was MRI in 29.3% overall, with lower MRI rates among duals and MA members. Authors describe imaging as 'substantially underused'."
 },
 {
  "metric": "Receipt of guideline-recommended structural brain imaging (MRI or CT) within 365 days of a new cognitive-impairment diagnosis",
  "group_a": "Traditional Medicare, non-dual beneficiaries",
  "group_b": "Medicare Advantage, non-dual beneficiaries",
  "value_a": 60.5,
  "value_b": 54.35,
  "unit": "percent",
  "ratio_or_difference": "+6.15 percentage points",
  "year": "2021 diagnoses (data 2020-2022; published 2026)",
  "population": "1,095,947 community-dwelling Medicare beneficiaries aged 65-84 newly diagnosed with cognitive impairment in 2021, 100% TM and MA data",
  "source_name": "Mattke S, Liu Y, Ye W, Altunkaynak K. Structural brain imaging for newly diagnosed cognitive impairment by Medicare coverage type. J Am Coll Radiol 2026 (online)",
  "source_url": "https://doi.org/10.1016/j.jacr.2026.09.002",
  "notes": "PMID 42744196. MEASURED. The 54.35% figure is printed as such in the abstract (likely 54.3%). Gap 'accentuated in Medicare Advantage Plan members and the socioeconomically disadvantaged dually eligibles'."
 },
 {
  "metric": "Neurologist density by hospital referral region quintile",
  "group_a": "Highest-density quintile of regions",
  "group_b": "Lowest-density quintile of regions",
  "value_a": 43.1,
  "value_b": 9.7,
  "unit": "neurologists per 100,000 Medicare beneficiaries",
  "ratio_or_difference": "4.4x (43.1/9.7)",
  "year": "2015 (published 2021)",
  "population": "20% sample of 2015 Medicare beneficiaries summarized by hospital referral region",
  "source_name": "Lin CC, Callaghan BC, Burke JF, et al. Geographic Variation in Neurologist Density and Neurologic Care in the United States. Neurology 2021;96(3):e309-e321",
  "source_url": "https://doi.org/10.1212/WNL.0000000000011276",
  "notes": "PMID 33361251; PMC7884982. MEASURED (95% CI 37.6-48.5 vs 9.2-10.2). Prevalence of neurologic conditions did not differ substantially across quintiles (311 vs 293 per 1,000). Share of patients with a neurologic condition seen by a neurologist: 27.0% in highest- vs 20.6% in lowest-density regions, and most of that difference comprised dementia, pain and stroke, i.e., dementia specialist access is what varies with supply."
 },
 {
  "metric": "Share of Medicare patients with a neurologic condition who saw a neurologist",
  "group_a": "Highest neurologist-density quintile of regions",
  "group_b": "Lowest neurologist-density quintile of regions",
  "value_a": 27.0,
  "value_b": 20.6,
  "unit": "percent",
  "ratio_or_difference": "+6.4 percentage points",
  "year": "2015 (published 2021)",
  "population": "20% sample of 2015 Medicare beneficiaries with office-based visits for a neurologic condition, by hospital referral region",
  "source_name": "Lin CC, Callaghan BC, Burke JF, et al. Geographic Variation in Neurologist Density and Neurologic Care in the United States. Neurology 2021;96(3):e309-e321",
  "source_url": "https://doi.org/10.1212/WNL.0000000000011276",
  "notes": "PMID 33361251; PMC7884982. MEASURED. Overall 23.5% of patients with a neurologic condition were seen by a neurologist. Dementia was among the conditions whose neurologist involvement rose most with supply, unlike Parkinson disease and multiple sclerosis (>80% neurologist involvement even in low-supply regions)."
 },
 {
  "metric": "Risk-adjusted ADRD diagnostic incidence ratio, rural vs metropolitan counties",
  "group_a": "Rural counties",
  "group_b": "Metropolitan counties (reference)",
  "value_a": 1.14,
  "value_b": 1.0,
  "unit": "adjusted incidence ratio (metropolitan = 1.0)",
  "ratio_or_difference": "adjusted incidence 1.14x higher in rural counties while adjusted prevalence is 0.93x lower",
  "year": "2008-2015 (published 2021)",
  "population": "National fee-for-service Medicare claims, roughly 170 million person-years, beneficiaries in metropolitan, micropolitan and rural counties",
  "source_name": "Rahman M, White EM, Mills C, Thomas KS, Shireman TI. Rural-urban differences in diagnostic incidence and prevalence of Alzheimer's disease and related dementias. Alzheimers Dement 2021;17(7):1213-1230",
  "source_url": "https://doi.org/10.1002/alz.12285",
  "notes": "PMID 33663019; PMC8277695 (full text loaded). MEASURED claims with statistical adjustment for beneficiary and zip-code characteristics. Unadjusted incidence and prevalence were lower in rural counties; after adjustment incidence was higher (1.14x rural, 1.08x micropolitan) but prevalence lower (0.93x rural, 0.95x micropolitan), and the rural-urban prevalence gap fell from 1 to 0.5 percentage points. Age at ADRD diagnosis was about six months younger in rural counties. Adjusted 365-day survival after a 2008 diagnosis: 80% metropolitan vs 79% rural/micropolitan. Authors interpret the pattern as under-diagnosis and/or later-stage diagnosis in rural areas."
 },
 {
  "metric": "County-level ADRD diagnostic prevalence among Medicare beneficiaries, adjusted prevalence ratio",
  "group_a": "Rural counties (Kentucky and West Virginia)",
  "group_b": "Urban counties (Kentucky and West Virginia)",
  "value_a": 0.89,
  "value_b": 1.0,
  "unit": "adjusted prevalence ratio (urban = 1.0)",
  "ratio_or_difference": "11% lower in rural counties (95% CI 9%-13% lower)",
  "year": "2013 (CMS public use files 2007-2013; published 2016)",
  "population": "All Medicare beneficiaries by county in Kentucky and West Virginia; Rural-Urban Continuum Codes; ecologic Poisson regression",
  "source_name": "Abner EL, Jicha GA, Christian WJ, Schreurs BG. Rural-Urban Differences in Alzheimer's Disease and Related Disorders Diagnostic Prevalence in Kentucky and West Virginia. J Rural Health 2016;32(3):314-320",
  "source_url": "https://doi.org/10.1111/jrh.12155",
  "notes": "PMID 26515331; PMC5056321. MEASURED diagnoses but ECOLOGIC design (county-level), adjusted for state, mean age, % female, % Medicaid-eligible, Central Appalachian county and enrollment shares. Authors caution that younger, more male rural beneficiary populations could contribute and call for individual-level confirmation."
 },
 {
  "metric": "Hazard of incident dementia diagnosis by neighborhood deprivation (Area Deprivation Index quintile)",
  "group_a": "Most disadvantaged neighborhood quintile (ADI Q5)",
  "group_b": "Least disadvantaged quintile (ADI Q1, reference)",
  "value_a": 1.22,
  "value_b": 1.0,
  "unit": "adjusted hazard ratio (Q1 = 1.0)",
  "ratio_or_difference": "HR 1.22 (95% CI 1.21-1.24); gradient Q2 1.09, Q3 1.14, Q4 1.16",
  "year": "FY2000-FY2021 (published 2023)",
  "population": "1,637,484 US Veterans Health Administration patients (98.0% men; mean age 68.6; 86.9% White, 9.3% Black), mean follow-up 11.0 years; 12.8% developed dementia",
  "source_name": "Dintica CS, Bahorik A, Xia F, Kind A, Yaffe K. Dementia Risk and Disadvantaged Neighborhoods. JAMA Neurol 2023;80(9):903-909",
  "source_url": "https://doi.org/10.1001/jamaneurol.2023.2120",
  "notes": "PMID 37464954; PMC10357362. MEASURED (claims diagnoses), Cox models with age as time scale adjusted for sex, race/ethnicity and psychiatric/medical comorbidities; competing-risk (Fine-Gray) results similar. Nearly all-male veteran sample limits generalization to women."
 },
 {
  "metric": "Hospice use for 3 or more days in the last 6 months of life",
  "group_a": "Black decedents",
  "group_b": "White decedents",
  "value_a": 34.9,
  "value_b": 46.2,
  "unit": "percent",
  "ratio_or_difference": "-11.3 percentage points; adjusted OR 0.72 (95% CI 0.54-0.96)",
  "year": "Deaths 2013-2015 (published 2020)",
  "population": "1,212 REGARDS cohort participants with fee-for-service Medicare who died of natural (non-sudden) causes 2013-2015 (378 Black, 834 White; mean age at death 81.0); cause of death adjudicated, models adjusted for cause including dementia",
  "source_name": "Ornstein KA, Roth DL, Huang J, et al. Evaluation of Racial Disparities in Hospice Use and End-of-Life Treatment Intensity in the REGARDS Cohort. JAMA Netw Open 2020;3(8):e2014639",
  "source_url": "https://doi.org/10.1001/jamanetworkopen.2020.14639",
  "notes": "PMID 32833020; PMC7445597. MEASURED (132/378 vs 385/834; P<.001). Not dementia-specific: dementia was one adjudicated cause-of-death category in the adjusted model. Black decedents also had higher odds of multiple ED visits (OR 1.35), hospitalizations (OR 1.39) and intensive treatment (OR 1.94) in the last 6 months. Differences were concentrated in non-cancer deaths."
 },
 {
  "metric": "Feeding-tube placement in the last year of life among decedents with dementia or Parkinson disease",
  "group_a": "Black decedents",
  "group_b": "White decedents (reference)",
  "value_a": 2.96,
  "value_b": 1.0,
  "unit": "adjusted hazard ratio (White = 1.0)",
  "ratio_or_difference": "aHR 2.96 (95% CI 2.70-3.24)",
  "year": "2013-2017 (published 2024)",
  "population": "70,650 fee-for-service Medicare decedents in North and South Carolina diagnosed with dementia (93.1%) or Parkinson disease (7.7%) at age 50+ (13,753 Black, 55,765 White)",
  "source_name": "Goetz ME, Ford CB, Greiner MA, et al. Racial Disparities in Low-Value Care in the Last Year of Life for Medicare Beneficiaries With Neurodegenerative Disease. Neurol Clin Pract 2024;14(2):e200273",
  "source_url": "https://doi.org/10.1212/CPJ.0000000000200273",
  "notes": "PMID 38524836; PMC10955333. MEASURED, adjusted for age, sex, dual enrollment, rurality, state and comorbidities. Feeding tubes in advanced dementia are a Choosing Wisely low-value service. Black decedents were also more likely to get colorectal cancer screening (aHR 1.46) and peripheral artery stenting (aHR 1.72), be hospitalized (aHR 1.28) and admitted to skilled nursing (aHR 1.09), and less likely to receive hospice (aHR 0.82, 0.79-0.85), physical therapy (aHR 0.73) or dementia medications (aHR 0.90). Two-state sample."
 },
 {
  "metric": "Initiation of anti-dementia (cholinesterase inhibitor/memantine) drugs by deprivation quintile, UK primary care",
  "group_a": "Least deprived quintile (Townsend score)",
  "group_b": "Most deprived quintile (reference)",
  "value_a": 1.25,
  "value_b": 1.0,
  "unit": "adjusted incidence rate ratio (most deprived = 1.0)",
  "ratio_or_difference": "IRR 1.25 (95% CI 1.19-1.31): least deprived 25% more likely to be started on treatment",
  "year": "2002-2013 (published 2016)",
  "population": "77,045 UK primary-care patients with a recorded dementia diagnosis or anti-dementia prescription",
  "source_name": "Cooper C, Lodwick R, Walters K, et al. Observational cohort study: deprivation and access to anti-dementia drugs in the UK. Age Ageing 2016;45(1):148-154",
  "source_url": "https://doi.org/10.1093/ageing/afv154",
  "notes": "PMID 26582758; PMC4711654. MEASURED. Gradient driven by English practices; in Scotland, Northern Ireland and Wales prescribing was unrelated to deprivation. Prescribing also higher in Northern Irish (IRR 1.81) and lower in Welsh (0.68) practices vs England, and higher in younger people and men. Non-US record included because it quantifies an income gradient in access to symptomatic dementia drugs."
 },
 {
  "metric": "Crude 1-year mortality after incident dementia diagnosis",
  "group_a": "Male Medicare beneficiaries with dementia",
  "group_b": "Female Medicare beneficiaries with dementia",
  "value_a": 27.2,
  "value_b": 21.8,
  "unit": "percent",
  "ratio_or_difference": "+5.4 percentage points; unadjusted HR 1.30 (95% CI 1.29-1.31), adjusted HR 1.24 (1.23-1.26)",
  "year": "2014-2021 (published 2025)",
  "population": "5,721,711 fee-for-service Medicare beneficiaries aged 65+ with incident ICD-10 dementia diagnosis 2014-2021 (3,302,579 female; 2,419,132 male), up to 8 years follow-up",
  "source_name": "Lusk JB, Ford CB, Soneji S, et al. Sex Differences in Mortality and Health Care Utilization After Dementia Diagnosis. JAMA Neurol 2025;82(10):1048-1056",
  "source_url": "https://doi.org/10.1001/jamaneurol.2025.2236",
  "notes": "PMID 40788638; PMC12340678. MEASURED (P<.001). Adjustment for age, race/ethnicity, dual eligibility, comorbidity and access to care attenuated the hazard only modestly. Men also had higher 1-year hospitalization (50.5% vs 46.9%; adjusted HR 1.08) and higher hazards of hospice, neuroimaging and hospitalization for behavioural disturbance. Complements the female-predominant prevalence records."
 },
 {
  "metric": "Amyloid-PET positivity among matched patients with MCI or dementia (original IDEAS study)",
  "group_a": "White participants",
  "group_b": "Asian participants",
  "value_a": 57.8,
  "value_b": 45.4,
  "unit": "percent",
  "ratio_or_difference": "+12.4 percentage points (P=.001); adjusted OR for positivity 0.47 (95% CI 0.37-0.59) for Asian vs White",
  "year": "2016-2017 scans (published 2022)",
  "population": "17,107 Medicare beneficiaries with MCI or dementia meeting amyloid-PET appropriate-use criteria at 595 US dementia specialist practices, Feb 2016-Sep 2017 (321 Asian, 635 Black, 829 Hispanic, 15,322 White); 1:1 matched analyses",
  "source_name": "Wilkins CH, Windon CC, Dilworth-Anderson P, et al. Racial and Ethnic Differences in Amyloid PET Positivity in Individuals With Mild Cognitive Impairment or Dementia: A Secondary Analysis of the IDEAS Cohort Study. JAMA Neurol 2022;79(11):1139-1147",
  "source_url": "https://doi.org/10.1001/jamaneurol.2022.3157",
  "notes": "PMID 36190710; PMC9531087. MEASURED in optimal 1:1 matched pairs (181/313 vs 142/313). Lower amyloid positivity in Asian, Hispanic and Black patients with the same clinical syndrome implies more non-Alzheimer causes of cognitive impairment, which affects eligibility for anti-amyloid drugs. Distinct from the New IDEAS record already in this dataset."
 },
 {
  "metric": "Amyloid-PET positivity among matched patients with MCI or dementia (original IDEAS study)",
  "group_a": "White participants",
  "group_b": "Hispanic participants",
  "value_a": 61.8,
  "value_b": 54.5,
  "unit": "percent",
  "ratio_or_difference": "+7.3 percentage points (P=.003); adjusted OR 0.68 (95% CI 0.59-0.79) for Hispanic vs White",
  "year": "2016-2017 scans (published 2022)",
  "population": "17,107 Medicare beneficiaries with MCI or dementia meeting amyloid-PET appropriate-use criteria at 595 US dementia specialist practices, Feb 2016-Sep 2017 (321 Asian, 635 Black, 829 Hispanic, 15,322 White); 1:1 matched analyses",
  "source_name": "Wilkins CH, Windon CC, Dilworth-Anderson P, et al. Racial and Ethnic Differences in Amyloid PET Positivity in Individuals With Mild Cognitive Impairment or Dementia: A Secondary Analysis of the IDEAS Cohort Study. JAMA Neurol 2022;79(11):1139-1147",
  "source_url": "https://doi.org/10.1001/jamaneurol.2022.3157",
  "notes": "PMID 36190710; PMC9531087. MEASURED in matched pairs (482/780 vs 425/780)."
 },
 {
  "metric": "Amyloid-PET positivity among matched patients with MCI or dementia (original IDEAS study)",
  "group_a": "White participants",
  "group_b": "Black participants",
  "value_a": 58.4,
  "value_b": 54.1,
  "unit": "percent",
  "ratio_or_difference": "+4.3 percentage points, NOT significant in matched analysis (P=.13); adjusted OR 0.71 (95% CI 0.60-0.84) for Black vs White in the full regression",
  "year": "2016-2017 scans (published 2022)",
  "population": "17,107 Medicare beneficiaries with MCI or dementia meeting amyloid-PET appropriate-use criteria at 595 US dementia specialist practices, Feb 2016-Sep 2017 (321 Asian, 635 Black, 829 Hispanic, 15,322 White); 1:1 matched analyses",
  "source_name": "Wilkins CH, Windon CC, Dilworth-Anderson P, et al. Racial and Ethnic Differences in Amyloid PET Positivity in Individuals With Mild Cognitive Impairment or Dementia: A Secondary Analysis of the IDEAS Cohort Study. JAMA Neurol 2022;79(11):1139-1147",
  "source_url": "https://doi.org/10.1001/jamaneurol.2022.3157",
  "notes": "PMID 36190710; PMC9531087. MEASURED in matched pairs (359/615 vs 333/615). Recorded as a null matched comparison alongside a significant adjusted-model result; the two approaches disagree, so treat the Black-White difference as uncertain."
 },
 {
  "metric": "Association between cumulative residential segregation exposure and processing-speed (DSST) z-score in midlife, CARDIA cohort",
  "group_a": "High cumulative residential segregation exposure, ages ~25-50 (25-year follow-up)",
  "group_b": "Low segregation exposure (reference)",
  "value_a": -0.37,
  "value_b": 0.0,
  "unit": "beta coefficient, DSST z-score points (reference = 0)",
  "ratio_or_difference": "-0.37 SD (95% CI -0.61 to -0.13) for high vs low segregation exposure; medium exposure -0.25 SD (95% CI -0.51 to 0.0002), not distinguishable from zero",
  "year": "1985-2010 (published 2020)",
  "population": "1,568 Black CARDIA cohort participants with year-25 cognition data (mean baseline age 25; 59.7% women), examined 2010",
  "source_name": "Caunca MR, Odden MC, Glymour MM, et al. Association of Racial Residential Segregation Throughout Young Adulthood and Cognitive Performance in Middle-aged Participants in the CARDIA Study. JAMA Neurol 2020;77(8):1000-1007",
  "source_url": "https://doi.org/10.1001/jamaneurol.2020.0860",
  "notes": "PMID 32364578; PMC7199173. MEASURED (marginal structural models with inverse probability weighting, accounting for time-varying confounding). Segregation measured via the Getis-Ord Gi* statistic; effect is among Black participants only (CARDIA also enrolled White participants, not analyzed here). Outcome is midlife processing speed, not a dementia diagnosis; authors note this may partly explain Black-White disparities in dementia risk at older age."
 },
 {
  "metric": "Association between neighborhood racial/ethnic composition and language-test z-score, older Northern Manhattan residents",
  "group_a": "Block groups with higher proportion of minoritized residents",
  "group_b": "Block groups with lower proportion of minoritized residents (reference)",
  "value_a": -0.05,
  "value_b": 0.0,
  "unit": "beta coefficient, language test z-score, SD units (reference = 0)",
  "ratio_or_difference": "-0.05 SD lower language score in block groups with a higher proportion of minoritized residents; block groups with higher potential intergroup contact (a separate segregation index in the same study) showed +0.06 to +0.1 SD higher language scores",
  "year": "published 2021",
  "population": "Older residents of Northern Manhattan, New York (mean age 75.7 years); language-test analytic sample n=4,333",
  "source_name": "Pohl DJ, Seblova D, Avila JF, et al. Relationship between Residential Segregation, Later-Life Cognition, and Incident Dementia across Race/Ethnicity. Int J Environ Res Public Health 2021;18(21):11233",
  "source_url": "https://doi.org/10.3390/ijerph182111233",
  "notes": "PMID 34769752; PMC8583156. MEASURED (multilevel linear models with block-group-level segregation indices -- dissimilarity, isolation and interaction -- adjusted for socioeconomic and health factors). Associations were smaller/less consistent for memory, visuospatial ability and incident dementia than for the language-score result shown here; abstract reports non-Hispanic Black adults were most likely to show negative cognitive associations with segregation but does not give a single pooled race-specific effect size."
 }
]