Assessment of Racial/Ethnic Disparities in Timeliness and Comprehensiveness of Dementia Diagnosis in California
Open accessAbstract
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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Diagnosis delays are greater among individuals from racial and ethnic minority groups.
“with greater delays among individuals from racial and ethnic minority groups.”
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- Authors
- Tsoy, E., Kiekhofer, R. E., Guterman, E. L., Tee, B. L., Windon, C. C., Dorsman, K. A., Lanata, S. C., Rabinovici, G. D., Miller, B. L., Kind, A. J. H., & Possin, K. L.
- Affiliations
- University of California, San Francisco (US)
- The University of Texas Southwestern Medical Center (US)
- University of Wisconsin–Madison (US)
- Corresponding author
- Possin, Katherine L.
- ORCID
- Venue
- JAMA Neurology
- Publisher
- American Medical Association (AMA)
- Published
- 2021-06-01
- Volume
- 78
- Issue
- 6
- Pages
- 657
- ISSN
- 2168-6149 (ISSN-L)
- PMC
- PMC8008426
- OpenAlex
- W3146388672
- Cited by
- 182
- References
- 41
- Citations by year
- 2026: 38 · 2025: 44 · 2024: 50 · 2023: 25 · 2022: 20 · 2021: 5
- FWCI
- 17.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Neurology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute on Aging (R01AG037639, R01AG056715, P01AG019724, P30AG062422, R35AG072362, P30AG062715, R01AG070883, T32AG023481)
- National Institute of Neurological Disorders and Stroke (UH3NS105557)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- racial and ethnic disparities, dementia diagnosis, diagnostic timeliness, mild cognitive impairment, Medicare beneficiaries, Asian Americans, African Americans, Hispanic Americans, neuroimaging, laboratory testing, health care access, California, population aging, health equity, health care costs, quality of care
- MeSH terms
- Aged, Aged, 80 and over, California, Cross-Sectional Studies, Dementia, Ethnicity, Female, Medicare, Humans, Male, Retrospective Studies, United States, Fee-for-Service Plans, Racial Groups, Healthcare Disparities, Delayed Diagnosis
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