Ethnic disparities in the uptake of anti-dementia medication in young and late-onset dementia.

Clarissa Giebel,Aravind Komuravelli,Monica Cations,Brian Draper

doi:10.1017/s1041610220000794

Abstract

People with dementia can face barriers when trying to access care after a diagnosis, particularly in young-onset dementia (YOD). Little is known about the effects of ethnicity on the use of anti-dementia medication and variations between age groups. The aim of this study was to analyze national data on variations in the uptake of anti-dementia medication between people with YOD and late-onset dementia (LOD). Cross-sectional longitudinal cohort study. Data from the U.S. National Alzheimer's Coordinating Centre were obtained from September 2005 to March 2019. First visits of people with a diagnosis of Alzheimer's disease (AD) dementia, Lewy body dementia (LBD), and Parkinson's disease dementia (PDD) were included. Logistic regression was used to analyze the effects of education and ethnicity on use of cholinesterase inhibitors and memantine, accounting for YOD/LOD, gender, living situation, severity stage, and comorbidities. In total, 15,742 people with AD dementia and LBD/PDD were included, with 11,019 PwD having completed a first follow-up visit. Significantly more people with YOD used memantine than those with LOD, while fewer used cholinesterase inhibitors. PwD from minority ethnic backgrounds used memantine and cholinesterase inhibitors less often than those from a White ethnic background. Logistic regression analysis showed that ethnicity was a significant determinant of both memantine and cholinesterase inhibitors usage, while education was only a significant determinant for memantine usage. Findings highlight the impact of social factors on current usage of anti-dementia medication and the need for more resources to enable equitable use of anti-dementia medication.

Highlights

Dementia affects an estimated 50 million people worldwide (Alzheimer’s Disease International, 2016)
Findings highlight the impact of social factors on current usage of anti-dementia medication and the need for more resources to enable equitable use of anti-dementia medication
This study used data from the United States National Alzheimer’s Coordinating Center (NACC) dataset, which collects longitudinal data from 34 Alzheimer’s Disease Centers (ADC) across the U.S.A. on demographic characteristics, dementia progression, and clinical diagnosis by clinicians from people with any cognitive status living in the community and long-term care institutions (Beekly et al, 2007; Morris et al, 2006)

Summary

Introduction

Dementia affects an estimated 50 million people worldwide (Alzheimer’s Disease International, 2016). Not every person with dementia (PwD) receives equal access to care after their diagnosis (Cooper et al, 2016), if they even get access to a diagnosis in the first place (Mayeda et al, 2016). Socio-economic status (SES) can affect access to general health care utilization and treatments (Brinda et al, 2016; Giebel et al, 2019a; Saini et al, 2020), including education, gender, ethnicity, poor housing, debts, and income. Research into the effects of SES on dementia treatment is limited. Cooper and colleagues (2016) report that people from more advantaged backgrounds were 25% more likely to receive access to anti-dementia medication compared to people with dementia from more disadvantaged backgrounds. People from Black and minority ethnic (BME) groups are frequently reported to experience difficulties in accessing post-diagnostic dementia care

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