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. 2021 Jun 1;78(6):657-665.
doi: 10.1001/jamaneurol.2021.0399.

Assessment of Racial/Ethnic Disparities in Timeliness and Comprehensiveness of Dementia Diagnosis in California

Elena Tsoy  1 , Rachel E Kiekhofer  1 , Elan L Guterman  2 , Boon Lead Tee  1 , Charles C Windon  1 , Karen A Dorsman  3 , Serggio C Lanata  1   4 , Gil D Rabinovici  1   5   6 , Bruce L Miller  1   4 , Amy J H Kind  7   8 , Katherine L Possin  1   4
Affiliations

Assessment of Racial/Ethnic Disparities in Timeliness and Comprehensiveness of Dementia Diagnosis in California

Elena Tsoy et al. JAMA Neurol. .

Abstract

Importance: The US aging population is rapidly becoming more racially and ethnically diverse. Early diagnosis of dementia is a health care priority.

Objective: To examine the associations between race/ethnicity and timeliness of dementia diagnosis and comprehensiveness of diagnostic evaluation.

Design, setting, and participants: This retrospective cross-sectional study used 2013-2015 California Medicare fee-for-service data to examine the associations of race/ethnicity, individual factors, and contextual factors with the timeliness and comprehensiveness of dementia diagnosis. Data from 10 472 unique beneficiaries were analyzed. The sample was selected on the basis of the following criteria: presence of 1 or more claims; no diagnoses of dementia or mild cognitive impairment in 2013 to 2014; continuous enrollment in Medicare Parts A and B; Asian, Black, Hispanic, or White race/ethnicity; and incident diagnoses of dementia or mild cognitive impairment in January through June 2015. Data analyses were conducted from November 1, 2019, through November 10, 2020.

Main outcomes and measures: Timeliness of diagnosis, defined as incident diagnosis of mild cognitive impairment vs dementia, and comprehensiveness of diagnostic evaluation, defined as presence of the following services in claims within 6 months before or after the incident diagnosis date: specialist evaluation, laboratory testing, and neuroimaging studies.

Results: The sample comprised 10 472 unique Medicare beneficiaries with incident diagnoses of dementia or mild cognitive impairment (6504 women [62.1%]; mean [SD] age, 82.9 [8.0] years) and included 993 individuals who identified as Asian (9.5%), 407 as Black (3.9%), 1255 as Hispanic (12.0%), and 7817 as White (74.6%). Compared with White beneficiaries, those who identified as Asian (odds ratio, 0.46; 95% CI, 0.38-0.56), Black (odds ratio, 0.73; 95% CI, 0.56-0.94), or Hispanic (odds ratio, 0.62; 95% CI, 0.52-0.72) were less likely to receive a timely diagnosis. Asian beneficiaries (incidence rate ratio, 0.81; 95% CI, 0.74-0.87) also received fewer diagnostic evaluation elements. These associations remained significant after adjusting for age, sex, comorbidity burden, neighborhood disadvantage, and rurality.

Conclusions and relevance: These findings highlight substantial disparities in the timeliness and comprehensiveness of dementia diagnosis. Public health interventions are needed to achieve equitable care for people living with dementia across all racial/ethnic groups.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Guterman reported receiving grant funding from the National Institute of Neurological Disorders and Stroke (1K23NS116128-01), the National Institute on Aging (5R01AG056715), and the American Academy of Neurology; and receiving consulting fees from Marinus Pharmaceuticals Inc and honoraria from Knowledge to Practice. Dr Rabinovici reported receiving grants from Avid Radiopharmaceuticals, Eli Lilly, GE Healthcare, Life Molecular Imaging; and personal fees from Eisai, Johnson & Johnson, GE Healthcare, Axon Neurosciences, Eisai, Roche, Genetech, and Merck; and research funding from the National Institutes of Health (NIH), the Rainwater Charitable Foundation, and the Alzheimer’s Association outside the submitted work. Dr Miller reported serving on the Cambridge National Institute for Health Research Biomedical Research Centre advisory committee and its subunit, the Biomedical Research Unit in Dementia; serving as a board member for the American Brain Foundation; serving on John Douglas French Alzheimer’s Foundation board of directors; serving on the Safely You board of directors; serving as scientific director for the Tau Consortium; serving as medical advisor for and receiving a grant from The Bluefield Project for Frontotemporal Dementia Research; serving as a consultant for Rainwater Charitable Foundation, Stanford Alzheimer’s Disease Research Center, Buck Institute SAB, Larry L. Hillblom Foundation, University of Texas Center for Brain Health, University of Washington Alzheimer’s Disease Research Center EAB, and Harvard University Alzheimer’s Disease Research Center EAB; receiving royalties from Guilford Press, Cambridge University Press, Johns Hopkins Press, and Oxford University Press; serving as editor for Neurocase; serving as section editor for Frontiers in Neurology; and receiving grants P30 AG062422, P01 AG019724, R01 AG057234, and T32 AG023481 from the NIH. Dr Kind reported receiving grants from the NIH during the conduct of the study; grants from the NIH, the US Department of Veterans Affairs, and the Commonwealth Foundation outside the submitted work; and consulting fees from the University of Wisconsin–Health’s Isthmus Project. Dr Possin reported receiving grants from the National Institute on Aging and the National Institute of Neurological Disorders and Stroke during the conduct of the study; grants from Global Brain Health Institute, Quest Diagnostics, Administration for Community Living, Rainwater Charitable Trust, and Merck Foundation outside the submitted work; and personal fees from ClearView Health Partners and Vanguard. No other disclosures were reported.

Figures

Figure.
Figure.. Adjusted Odds Ratios and Incidence Rate Ratios of Timely Diagnosis and Number of Recommended Diagnostic Services by Race/Ethnicity, Individual Factors, and Contextual Factors
Dotted line indicates the reference group estimate (White, male, mid–area deprivation index [ADI], and metropolitan). HC indicates high commute; LC, low commute.
See this image and copyright information in PMC

Comment in

References

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