Racial/Ethnic Differences in Health-Related Quality of Life in Persons With and Without Dementia.

Abstract

Given the lack of effective pharmacologic strategies to prevent, slow, or reverse dementia progression, maximizing quality of life (QOL) is a major priority for persons living with dementia. Despite well-documented racial/ethnic disparities in dementia incidence and prevalence, it is unknown whether there are racial/ethnic disparities in QOL among persons with dementia. The objective of this study was to determine if there are racial/ethnic differences in poor health-related quality of life (HRQOL) among persons with and without dementia in a nationally-representative cohort. Repeated measures cross-sectional analysis of a prospective cohort study. United States nationally-representative National Health and Aging Trends Study (2011-2018). Non-nursing home-dwelling Black, Latino, and white adults age 65+ (n = 10,886). We estimated racial/ethnic differences in five dichotomous indicators of poor HRQOL (depressive and anxiety symptoms, self-rated health, pain, and physical functional limitations), stratified by dementia status (probable, possible, none). We used generalized estimating equations to estimate prevalence ratios (PRs) and differences, and marginal standardization to estimate prevalence. Generally, Blacks and Latinos reported higher prevalence of poor HRQOL compared with whites. The largest differences were observed for self-rated health, and Latino-white differences were slightly larger compared to Black-white differences. PRs were larger among those with no dementia. For example, the Black versus white PRs for poor self-rated health were 1.93 (95% confidence interval (CI) = 1.82-2.04) among the no dementia group and 1.21 (95% CI = 1.12-1.31) among the probable dementia group; Latino versus white PRs for these comparisons were 2.39 (2.21-2.59) and 1.48 (1.35-1.62), respectively. Prevalence differences also showed racial/ethnic differences, but these were similar across dementia statuses. We observed racial/ethnic disparities in poor HRQOL, showing greater unmet clinical needs among Black and Latino versus white older adults. Relative disparities were smaller in those with dementia, but absolute magnitudes of disparities were similar by dementia status.