Understanding Impacts of Randomized COVID-19 Vaccine Invitations on Older Adults with Alzheimer’s Disease and Related Dementias (ADRD)

Older adults with Alzheimer’s Disease and Related Dementias (ADRD) are at high risk for severe COVID-19 outcomes and have been disproportionately represented in confirmed COVID-19 cases, hospitalizations, and deaths. While the development and dissemination of effective COVID-19 vaccines promised to reduce morbidity and mortality among ADRD patients, little is known about 1) how access to COVID-19 vaccination affected actual vaccine takeup, healthcare utilization, and health among older Americans with ADRD; 2) how disadvantage in vaccine takeup and related downstream utilization and health outcomes attributable to ADRD compares to disadvantage attributable to other sociodemographic and health factors that have been recently targeted by policymakers; and 3) the specific mechanisms that drive disparities in these outcomes between older Americans with and without ADRD. Leveraging novel administrative data on a real-world natural experiment in which a large health system randomly assigned COVID-19 vaccine invitations to patients aged 65 and older, our supplement will advance knowledge on all three of these questions. Central to our project is the laborious construction of a new, individual-level, highly-detailed dataset that combines fine-grained electronic medical records, vaccine registry data, and death records with archival data on the exact rollout of the vaccine invitations. Using this dataset, we will first estimate the causal impact of the randomized vaccine invitations on the vaccine takeup, health utilization, and health of older adults with ADRD. We then will compare disparities in these outcomes among older adults with ADRD to disparities among older adults in other groups by social vulnerability, health status, ethnicity, and race, providing important estimates that policymakers can use to calibrate targeting efforts that seek to close health inequities. We will proceed to examine the mechanisms that create disparities in these outcomes between Americans with and without ADRD, quantifying the relative importance of each to inform the design of interventions that can improve access to vaccination and other care among older Americans with ADRD. The project advances two of the highest research development priorities of the parent grant, the NBER Center for Aging and Health Research: The Health Impacts of the COVID-19 Pandemic, and the Economics of Alzheimer’s Disease and Related Dementias.