Comprehensive Diagnostic Services and Timely Diagnosis of Dementia Vary on the Basis of Ethnicity and Sociodemographic Characteristics

Jessica Nye, PhD
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An image of a brain made out of newspaper.
The study authors sought to examine the associations between race/ethnicity and timeliness of dementia diagnosis, as well as the comprehensiveness of diagnostic evaluation.

White patients were more likely to receive a timely diagnosis of dementia, according to results of a retrospective cross-sectional study published in JAMA Neurology.

Researchers from the University of California, San Francisco analyzed the Centers for Medicare & Medicaid administrative enrollment and claims from 2013 to 2015 in California. Patients (N=10,472) who received a diagnosis of dementia were assessed for demographics and clinical characteristics.

Patients were 62.1% women, aged mean 82.9 (standard deviation [SD], 8.0) years, 74.6% were White, 12.0% Hispanic, 9.5% Asian, and 3.9% Black.

Compared with White patients, Asians were less likely to be diagnosed with incident mild cognitive impairment (MCI; 12.3% vs 23.3%), to be evaluated by a specialist (28.8% vs 35.4%), or to have laboratory testing (10.2% vs 17.2%). Hispanic and Black patients had higher Elixhauser scores (mean, 5.1 and 5.2 vs 4.8) and were less likely to be diagnosed with incident MCI (15.8% and 18.2% vs 23.3%), respectively.

Diagnoses of incident MCI were less likely among patients who were Asian (adjusted odds ratio [aOR], 0.45; 95% CI, 0.37-0.55; P <.001), Hispanic (OR, 0.65; 95% CI, 0.55-0.77; P £.001), or Black (OR, 0.70; 95% CI, 0.53-0.91; P =.01). Incident MCI diagnoses were less common among those living in highly disadvantaged neighborhoods (OR, 0.73; 95% CI, 0.63-0.84; P <.001), with increasing age (5-year increment: OR, 0.80; 95% CI, 0.77-0.82; P <.001), and among patients with higher comorbidity burden (per comorbid condition: OR, 0.96; 95% CI, 0.94-0.98; P <.001).

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Compared with White patients, Asians were less likely to receive diagnostic workup services (adjusted incidence rate ratio [aIRR], 0.81; 95% CI, 0.75-0.87; P <.001), as were residents of disadvantaged neighborhoods (aIRR, 0.91; 95% CI, 0.86-0.96; P =.003), and older patients (5-year increment: aIRR, 0.98; 95% CI, 0.98-0.99; P <.001).

Interactions were observed between neighborhood disadvantage and timely diagnosis among Black patients (b, 0.713; standard error [SE], 0.318; P =.02) and with diagnostic services among Hispanic patients (b, 0.133; SE, 0.050; P =.03).

This study was based on fee-for-service claims in California and may not be generalizable to other populations of patients.

The study authors concluded Asian, Hispanic, and Black individuals received less timely diagnoses and fewer comprehensive evaluations for dementia than White patients.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Tsoy E, Kiekhofer RE, Guterman EL, et al. Assessment of racial/ethnic disparities in timeliness and comprehensiveness of dementia diagnosis in California. JAMA Neurol. Published online March 29, 2021. doi:10.1001/jamaneurol.2021.0399