Abstract
Background:With a growing elderly population worldwide, the prevalence of dementia is rapidly increasing. Studies from high income countries have shown that belonging to a minority ethnic group increases the risk of health disadvantages.Objective:The aim of the present registry-based study was to identify potential differences in diagnostics, treatment, and care of individuals with dementia focusing on foreign-born in Sweden and the impact of country level socioeconomic position (SEP).Methods:The study was based on a large dataset from the Swedish Dementia Registry (SveDem) and the Swedish Tax Agency’s population registry. Data on demographic variables, cognitive tests, clinical assessments, medication, diagnosis, and interventions initiated at diagnosis were collected. Country level SEP was determined by country of birth as classified by World Bank Country and Lending groups.Results:Of 57,982 patients with dementia registered in SveDem, 7,171 (12.4%) were foreign-born. The foreign-born were significantly younger at diagnosis (p < 0.001), had a lower MMSE score (p < 0.001), lower odds of receiving a specific dementia diagnosis (p < 0.001), lower use of acetylcholinesterase inhibitors (p < 0.001), and overall a higher use of neuroleptics compared with the Swedish-born group. The lower SEP, the greater differences to Swedish-born were seen in many of the examined variables.Conclusion:There were significant differences in dementia diagnostics, treatment, and care between foreign-born and Swedish-born, a lower SEP indicating greater differences. Further research should focus on various socioeconomic aspects and health care outcomes for a more profound analysis of equity in dementia care.
Highlights
Dementia is a growing international public health issue that affects the individual, the family, and society at large [1]
SEP, socioeconomic position; MMSE, Mini-Mental State Examination; LP, lumbar puncture; AChEI, acetylcholinesterase inhibitors; NMDA receptor antagonist, N-methyl-D-aspartate receptor antagonist. ∗p-values based on χ2 except for age and MMSE score based on analysis of variance (ANOVA). ∗∗Includes Alzheimer’s disease dementia, mixed dementia, Lewy Body dementia, and Parkinson’s disease dementia
The study results show that foreign-born registered in SveDem were significantly younger, had overall a higher female representation, and had a lower MMSE score at the time of diagnosis compared with Swedish-born
Summary
Dementia is a growing international public health issue that affects the individual, the family, and society at large [1]. The total number of people with dementia worldwide in 2010 was estimated to be about 35.6 million, and it is expected to double nearly every 20 years [2] Both the World Health Organization and Alzheimer’s Disease International [1] recognize dementia as a public health issue and advocate for action at international and national levels based on the principles of inclusion, integration, equity, and evidence [1]. Previous studies have shown differences in dementia prevalence and utilization of dementia care between majority and minority ethnic groups within a nation [3,4,5,6,7]. Objective: The aim of the present registry-based study was to identify potential differences in diagnostics, treatment, and care of individuals with dementia focusing on foreign-born in Sweden and the impact of country level socioeconomic position (SEP). Further research should focus on various socioeconomic aspects and health care outcomes for a more profound analysis of equity in dementia care
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