Gender Disparities in Anti-dementia Medication Use among Older Adults: Health Equity Considerations and Management of Alzheimer's Disease and Related Dementias.

Z Kevin Lu,Xiaomo Xiong,Xinyuan Wang,Jun Wu

doi:10.3389/fphar.2021.706762

Abstract

Objective: The prevalence of Alzheimer’s disease and related dementias (ADRD) in women is higher than men. However, the knowledge of gender disparity in ADRD treatment is limited. Therefore, this study aimed to determine the gender disparities in the receipt of anti-dementia medications among Medicare beneficiaries with ADRD in the U.S.Methods: We used data from the Medicare Current Beneficiary Survey 2016. Anti-dementia medications included cholinesterase inhibitors (ChEIs; including rivastigmine, donepezil, and galantamine) and N-methyl-D-aspartate (NMDA) receptor antagonists (including memantine). Descriptive analysis and multivariate logistic regression models were implemented to determine the possible gender disparities in the receipt of anti-dementia medications. Subgroup analyses were conducted to identify gender disparities among beneficiaries with Alzheimer’s disease (AD) and those with only AD-related dementias.Results: Descriptive analyses showed there were statistically significant differences in age, marital status, and Charlson comorbidities index (CCI) between Medicare beneficiaries who received and who did not receive anti-dementia medications. After controlling for covariates, we found that female Medicare beneficiaries with ADRD were 1.7 times more likely to receive anti-dementia medications compared to their male counterparts (odds ratio [OR]: 1.71; 95% confidence interval [CI]: 1.19–2.45). Specifically, among Medicare beneficiaries with AD, females were 1.2 times more likely to receive anti-dementia medications (Odds Radio: 1.20; 95% confidence interval: 0.58–2.47), and among the Medicare beneficiaries with only AD-related dementias, females were 1.9 times more likely to receive anti-dementia medications (OR: 1.90; 95% CI: 1.23–2.95).Conclusion: Healthcare providers should be aware of gender disparities in receiving anti-dementia medications among patients with ADRD, and the need to plan programs of care to support both women and men. Future approaches to finding barriers of prescribing, receiving and, adhering to anti-dementia medications by gender should include differences in longevity, biology, cognition, social roles, and environment.

Highlights

Alzheimer’s disease and related dementias (ADRD) are typical neurodegenerative diseases, including Alzheimer’s disease (AD) and common AD-related dementias, such as Lewy body dementia, vascular dementia, and mild cognitive impairment (Galasko et al, 1994; Deb et al, 2017)
Female Medicare beneficiaries with ADRD are 1.7 times more likely to receive anti-dementia medications compared to their male counterparts
We found significant gender disparities in the receipt of anti-dementia medications among patients with ADRD and those with only AD-related dementia, there were no significant disparities among patients with AD

Summary

Introduction

Alzheimer’s disease and related dementias (ADRD) are typical neurodegenerative diseases, including Alzheimer’s disease (AD) and common AD-related dementias, such as Lewy body dementia, vascular dementia, and mild cognitive impairment (Galasko et al, 1994; Deb et al, 2017). Anti-dementia medications are a class of drugs used to slow the progression of ADRD (Anand et al, 2017; McMichael et al, 2020). The anti-dementia medications approved by the US Food and Drug Administration (FDA) can be divided into two categories, including cholinesterase inhibitors (ChEIs; including rivastigmine, donepezil, and galantamine) and the N-methyl-D-aspartate (NMDA) receptor antagonists (including memantine) (Anand et al, 2017). A study shows that persistent treatment with anti-dementia medications can slow the clinical progression of ADRD (Rountree et al, 2009). The clinical guidelines for antidementia medications recommend that cholinesterase inhibitors are effective for mild to moderate ADRD, while memantine is helpful for moderate to severe ADRD (O’Brien et al, 2017)

Methods

Results

Discussion

Conclusion