Journal of the American Medical Directors Association · 2026
Disparities in the Setting of Initial Dementia Diagnosis: Influence of Race, Ethnicity, and Primary Care Use.
СтатьяПоддержка NIH: внешняя программаПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Bloschichak Aaron, Yang Ming-Ting, Makineni Rajesh, Qin Qiuyuan, Temkin-Greener Helena, Conwell Yeates, Cai Shubing
Аннотация
OBJECTIVE: Prior studies noted differences in care setting for initial diagnosis of Alzheimer disease and related dementias (ADRD), but racial and ethnic differences in first diagnosis setting remains unclear. This study investigates the differences in ADRD diagnosis by race and ethnicity and examines the association of these differences with primary care use.
DESIGN: We conducted a retrospective cohort study using 2022 Medicare Fee-for-Service (FFS) claims and enrollment files.
SETTING AND PARTICIPANTS: We analyzed individuals aged 65 years or older newly diagnosed with ADRD between July 1 and December 31, 2022. Our sample included 246,471 individuals.
METHODS: The main exposures of interest were race and ethnicity and recent primary care use (≥1 visit to a primary care provider in the 6 months prior to diagnosis). The primary outcome was setting of first ADRD diagnosis, categorized as community (eg, outpatient clinic, primary care office, specialist office), acute (inpatient or emergency department), or skilled nursing facilities or nursing homes (SNFs/NHs). We applied adjusted multinomial logistic regression models and quantified differences in probabilities with marginal effects.
RESULTS: Among the 246,471 beneficiaries with newly diagnosed ADRD, 50.4% were diagnosed in the community, 40.4% in acute settings, and 9.2% in SNFs/NHs. In the absence of primary care use, Black individuals were 2.7 percentage points (pp) less likely than White individuals to be diagnosed in the community. The opposite trends were seen for Hispanic (+4.6 pp) and Asian (+15.8 pp) individuals. With recent primary care use, these differences narrowed (+14.3 pp) for Asian, widened (+8.0 pp) for Hispanic, and were no longer observed (+1.2, P > .05) for Black individuals.
CONCLUSIONS AND IMPLICATIONS: Significant racial and ethnic differences existed in the settings in which ADRD diagnoses are made. Primary care engagement increased community-based diagnoses and reduced Black-White disparities, underscoring its role in promoting earlier ADRD detection.
DESIGN: We conducted a retrospective cohort study using 2022 Medicare Fee-for-Service (FFS) claims and enrollment files.
SETTING AND PARTICIPANTS: We analyzed individuals aged 65 years or older newly diagnosed with ADRD between July 1 and December 31, 2022. Our sample included 246,471 individuals.
METHODS: The main exposures of interest were race and ethnicity and recent primary care use (≥1 visit to a primary care provider in the 6 months prior to diagnosis). The primary outcome was setting of first ADRD diagnosis, categorized as community (eg, outpatient clinic, primary care office, specialist office), acute (inpatient or emergency department), or skilled nursing facilities or nursing homes (SNFs/NHs). We applied adjusted multinomial logistic regression models and quantified differences in probabilities with marginal effects.
RESULTS: Among the 246,471 beneficiaries with newly diagnosed ADRD, 50.4% were diagnosed in the community, 40.4% in acute settings, and 9.2% in SNFs/NHs. In the absence of primary care use, Black individuals were 2.7 percentage points (pp) less likely than White individuals to be diagnosed in the community. The opposite trends were seen for Hispanic (+4.6 pp) and Asian (+15.8 pp) individuals. With recent primary care use, these differences narrowed (+14.3 pp) for Asian, widened (+8.0 pp) for Hispanic, and were no longer observed (+1.2, P > .05) for Black individuals.
CONCLUSIONS AND IMPLICATIONS: Significant racial and ethnic differences existed in the settings in which ADRD diagnoses are made. Primary care engagement increased community-based diagnoses and reduced Black-White disparities, underscoring its role in promoting earlier ADRD detection.