Racial Disparities and Temporal Trends in Dementia Misdiagnosis Risk in the United States

Overview

Journal Alzheimers Dement (N Y)

Date 2020 Jan 1

PMID 31890853

Citations 79

Authors

Kan Z Gianattasio

Christina Prather

M Maria Glymour

Adam Ciarleglio

Melinda C Power

Affiliations

Soon will be listed here.

Abstract

Introduction: Systematic disparities in misdiagnosis of dementia across racial/ethnic groups have implications for health disparities. We compared the risk of dementia under- and overdiagnosis in clinical settings across racial/ethnic groups from 2000 to 2010.

Methods: We linked fee-for-service Medicare claims to participants aged ≥70 from the nationally representative Health and Retirement Study. We classified dementia status using an algorithm with similar sensitivity and specificity across racial/ethnic groups and assigned clinical dementia diagnosis status using ICD-9-CM codes from Medicare claims. Multinomial logit models were used to estimate relative risks of clinical under- and overdiagnosis between groups and over time.

Results: Non-Hispanic blacks had roughly double the risk of underdiagnosis as non-Hispanic whites. While primary analyses suggested a shrinking disparity over time, this was not robust to sensitivity analyses or adjustment for covariates. Risk of overdiagnosis increased over time in both groups.

Discussion: Our results suggest that efforts to reduce racial disparities in underdiagnosis are warranted.

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