Racial Differences in Inpatient Hospital Services Utilization and Expenditure between American Indian and Alaska Native and non‐Hispanic White Older Adults with Dementia

Abstract

AbstractBackgroundWhile American Indian and Alaska Native (AI/AN) and non‐Hispanic white (White) adults are at high risks for dementia, little is known about hospital utilization and expenditures among AI/ANs and Whites with dementia. The goal of this study is to examine characteristics associated with inpatient hospital services utilization and expenditures among AI/AN and White older adults with dementia, to understand what factors contribute to differences in utilization and expenditures between the two populations.MethodWe analyzed data on demographic characteristics, health coverage, chronic disease status, hospital utilization and expenditures from the CMS 2019 Medicare Master Beneficiary Summary File for all AI/AN (n = 16,324) and a 5% random sample of White (n = 139,335) adults aged ≥65 who had dementia in 2019. To examine associations between patient characteristics with utilization and expenditures, we employed Poisson and negative binomial models for utilization measures (1+ hospitalizations and number of inpatient hospital days) and a two‐part model (a gamma distribution with a log‐link function) for expenditures, while stratifying by race.ResultAI/AN adults were younger than White adults; a larger percentage were dually enrolled in Medicaid, had diabetes and ESRD, and lived in a rural county (p<0.01). Medicaid coverage is associated with higher inpatient hospital days and expenditures among AI/ANs (Incidence Rate Ratio (IRR) = 1.079; Marginal Effect (ME) = $3,313, p<0.01) but is associated with lower days and expenditures among Whites (IRR = 0.874; ME = ‐$1,438, p<0.01). The association between living in a rural county with expenditures followed a pattern similar to that of Medicaid coverage. Unadjusted mean hospital days and expenditures were 4.84 and $27,559 (AI/ANs) and 3.86 and $23,009 (Whites), respectively. When data for AI/ANs and Whites were combined, the average marginal expenditure for AI/ANs, compared to Whites was $4,550 in unadjusted model, but reduced to $2,772 when we adjusted for age, gender, comorbidities, and social determinants of health.ConclusionUnderstanding and addressing characteristics associated with racial differences in hospital use and expenditures among dementia patients may be helpful for health care resource planning and efficient use. In‐depth research is required to understand the contrasting differences in the impact of Medicaid on expenditures between AI/AN and White adults with dementia.