Migrating the National Long Term Care Survey to the MedRIC Health and Aging Data Enclave

Duke University, Durham NC

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Abstract

TITLE Migrating the National Long-Term Care Survey to the MedRIC Health and Aging Data Enclave ABSTRACT As life expectancy at age 65 continues to increase in the U.S., chronic diseases alone and in combination are placing an increasingly heavy burden on U.S. older adults and continue to be leading causes of disability and mortality. Alzheimer’s disease (AD) and related dementias (ADRD) have become important focal points for efforts to reduce the burden of chronic diseases on older adults. This is with good cause, as together with stroke, these conditions are the leading causes of cognitive impairment and associated loss of function and quality of life. However, AD/ADRD is but one aspect of unhealthy aging and operates in concert with other high impact adverse health conditions. Many of these conditions are leading causes of non-cognitive disability, and there is significant overlap of risk where one chronic illness imposes increased risk for the onset of others. An important aspect of preparing for the current and future burdens associated with chronic morbidity/multimorbidity in older ages is acquiring an understanding of whether these health trends are accompanied by a reduction in total lifetime days of chronic morbidity/disability—reflecting a balance between morbidity/disability incidence rates and case- continuance rates—generated by case-fatality and case-recovery rates. This is termed morbidity/mortality compression and is the primary focus of this Supplement’s parent grant (R01AG063971: 03/15/2020– 02/28/2025) which seeks to test two major hypotheses across three complementary Aims: [H1] that modifiable non-genetic risk factors account for the recent temporal changes in the incidence, prevalence, and continuance of cognitive and physical impairments; and [H2] that constitutional genetic and epigenetic factors modulate individual differences in lifetime morbidity/disability incidence, prevalence, and continuance of cognitive and physical impairments. To achieve these Aims, joint access to multiple CMS-linked data in a single location is necessary; but regulatory changes have made this challenging. These same regulatory changes also created unexpected opportunities: (1) to make the National Long Term Care Survey (NLTCS) available to NIA researchers on the Medicare & Medicaid Resource Information Center (MedRIC) Health and Aging Data (HaAD) Enclave—the future home of all NIA-sponsored CMS-linked studies—as a new CMS-linked data resource; and (2) to use the MedRIC HaAD enclave for the joint analysis of the CMS-linked datasets listed in the parent grant, thereby accelerating the rate of progress on its Aims. Exploiting both opportunities, with enhanced data analysis and comparative assessment of the HaAD enclave, is the goal of this Supplement. It presents a unique opportunity for formal review, evaluation, and recommendations for enhancement of the efficiency of the MedRIC HaAD enclave from the point of view of users and administrators of the NLTCS, with comparison of HaAD-based productivity gains to those achieved with two other CLOUD-based solutions at Duke University. All improvements in the efficiency of the HaAD enclave will benefit NIH/NIA researchers because the distribution of CMS data through the MedRIC HaAD enclave is expected to be the sole mode of distribution of these data in the future.