Makineni Rajesh, Bloschichak Aaron, Temkin-Greener Helena, Cai Shubing
Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
J Am Med Dir Assoc. 2025 Sep 3:105857. doi: 10.1016/j.jamda.2025.105857.
In 2017, the Chronic Condition Warehouse released a 30-condition Chronic Condition file (CC30), which fully replaced the prior 27-condition file (CC27) in 2022. CC30 shortened the look-back period for dementia identification from 3 to 2 years and raised the required outpatient/carrier claims from 1 to 2. This change may disproportionately affect individuals with limited access to health care. This study aimed to quantify how the CC27-CC30 transition affects dementia identification across population subgroups.
Observational study.
Medicare beneficiaries with dementia, including 12,951,241 person-years between 2018 and 2021.
We linked 2018-2021 Medicare Beneficiary Summary Files (base file, CC27, and CC30) with publicly available data. Beneficiaries with Alzheimer's disease (AD) or Alzheimer's disease and related dementias (ADRD) in either CC27 or CC30 were identified. Disagreement was defined as having dementia in one file but not the other. Logistic regression was used to examine patient-level (eg, race/ethnicity, dual status, age, gender) and area-level (eg, mental health provider shortages, social deprivation) factors associated with the disagreement.
CC30 identified approximately 70% to 72% of AD and ADRD cases in CC27, and added very few additional ADRD cases (0.04%). Disagreement (mainly driven by the exclusion of individuals previously identified by CC27) varied by individual and community characteristics. For example, Asian and Hispanic beneficiaries had 51% to 55% and 20% to 26% higher odds of disagreement for ADRD, respectively (P < .01). Rural residence was associated with an 11% to 13% increase in the odds of disagreement of ADRD (P < .01). Residents in communities with higher socioeconomic deprivation and lower proportions of White residents also had a higher likelihood of disagreement in ADRD dementia identification.
Transitioning from CC27 to CC30 reduces identified AD and ADRD dementia cases, disproportionately affecting certain subpopulations. Researchers and policymakers should consider these changes when interpreting trends and designing dementia care interventions.
2017年，慢性病数据库发布了一份包含30种疾病的慢性病文件（CC30），该文件于2022年全面取代了之前包含27种疾病的文件（CC27）。CC30将痴呆症识别的回顾期从3年缩短至2年，并将所需的门诊/医保报销次数从1次提高到2次。这一变化可能对获得医疗保健机会有限的个体产生不成比例的影响。本研究旨在量化从CC27到CC30的转变如何影响不同人群亚组的痴呆症识别情况。
观察性研究。
患有痴呆症的医疗保险受益人，包括2018年至2021年期间的12951241人年。
我们将2018 - 2021年医疗保险受益人汇总文件（基础文件、CC27和CC30）与公开可用数据相链接。识别出在CC27或CC30中患有阿尔茨海默病（AD）或阿尔茨海默病及相关痴呆症（ADRD）的受益人。不一致被定义为在一个文件中被认定患有痴呆症而在另一个文件中未被认定。使用逻辑回归来检验与不一致相关的患者层面（如种族/族裔、双重身份、年龄、性别）和地区层面（如心理健康服务提供者短缺、社会剥夺）因素。
CC30识别出了CC27中约70%至72%的AD和ADRD病例，并且新增的ADRD病例极少（0.04%）。不一致情况（主要由排除先前被CC27认定的个体所驱动）因个体和社区特征而异。例如，亚裔和西班牙裔受益人ADRD不一致的几率分别高出51%至55%和20%至26%（P <.01）。农村居民ADRD不一致的几率增加了11%至13%（P <.01）。社会经济剥夺程度较高且白人居民比例较低的社区居民在ADRD痴呆症识别中出现不一致的可能性也更高。
从CC27过渡到CC30会减少已识别的AD和ADRD痴呆症病例，对某些亚人群产生不成比例的影响。研究人员和政策制定者在解释趋势和设计痴呆症护理干预措施时应考虑这些变化。
