Time to dementia diagnosis by race: a retrospective cohort study.

TitleTime to dementia diagnosis by race: a retrospective cohort study.
Publication TypeJournal Article
Year of Publication2022
AuthorsDavis, MA, Lee, KA, Harris, M, Ha, J, Langa, KM, Bynum, JPW, Hoffman, GJ
JournalJournal of the American Geriatrics Society
ISSN Number1532-5415
KeywordsDementia, Diagnosis, Disparities, Medicare, race

BACKGROUND: Non-Hispanic Black individuals may be less likely to receive a diagnosis of dementia compared to non-Hispanic White individuals. These findings raise important questions regarding which factors may explain this observed association and any differences in the time to which disparities emerge following dementia onset.

METHODS: We conducted a retrospective cohort study using survey data from the 1995 to 2016 Health and Retirement Study linked with Medicare fee-for-service claims. Using the Hurd algorithm (a regression-based approach), we identified dementia onset among older adult respondents (age ≥65 years) from the Telephone Interview for Cognitive Status and proxy respondents. We determined date from dementia onset to diagnosis using Medicare data up to 3 years following onset using a list of established diagnosis codes. Cox Proportional Hazards modeling was used to examine the association between an individual's reported race and likelihood of diagnosis after accounting for sociodemographic characteristics, income, education, functional status, and healthcare use.

RESULTS: We identified 3435 older adults who experienced a new onset of dementia. Among them, 30.1% received a diagnosis within 36 months of onset. In unadjusted analyses, the difference in cumulative proportion diagnosed by race continued to increase across time following onset, p-value <0.001. 23.8% of non-Hispanic Black versus 31.4% of non-Hispanic White participants were diagnosed within 36 months of dementia onset, Hazard Ratio = 0.73 (95% CI: 0.61, 0.88). The association persisted after adjustment for functional status and healthcare use; however, these factors had less of an impact on the strength of the association than income and level of education.

CONCLUSION: Lower diagnosis rates of dementia among non-Hispanic Black individuals persists after adjustment for sociodemographic characteristics, functional status, and healthcare use. Further understanding of barriers to diagnosis that may be related to social determinants of health is needed to improve dementia-related outcomes among non-Hispanic Black Americans.

Citation Key12751
PubMed ID36200557
Grant List / / Institute for Social Research, University of Michigan, Ann Arbor, MI /
P01 AG019783 / AG / NIA NIH HHS / United States
P30 AG024824 / AG / NIA NIH HHS / United States
P30 AG053760 / AG / NIA NIH HHS / United States
P30 AG066582 / AG / NIA NIH HHS / United States
R01 AG053972 / AG / NIA NIH HHS / United States
U01 AG009740 / AG / NIA NIH HHS / United States
/ / U.S. Social Security Administration /