Racial/ethnic disparities in new and persistent cholinesterase inhibitors treatment in Alzheimer’s disease

Abstract

AbstractBackgroundRacial/ethnic minorities are less likely to use anti‐dementia medications and less likely to participate in dementia studies. It is unclear if treatment disparities remain in those who participate in longitudinal research at Alzheimer’s Disease Centers (ADCs).MethodsData were drawn from the National Alzheimer's Coordinating Center Uniform Data Set (9/2005‐11/2019). Baseline inclusion criteria: ≥65yo, etiology of AD, and CDR<3. Sample included Non‐Hispanic white, Non‐Hispanic Black, or Hispanic participants with ≥1 follow‐up. Main outcomes: (1) any new Acetylcholinesterase (AChEI) treatment during follow‐up, (2) persistence of treatment measured by proportion of follow‐up visits reporting AChEI use, categorized into: intermittent (<50% follow‐ups), persistent (≥50% follow‐ups), and always treated. Differences by race/ethnicity were estimated using logistic or ordered logistic regression models, controlling for participant clinical and demographic variables.ResultsSample included 5,866 white, 918 Black, and 608 Hispanic participants. Compare to the treated, those who were untreated at baseline were older, more likely to be female, lived alone, more likely to have AD (vs. MCI), with better clinical profiles (better CDR, FAQ, NPIQ, MMSE, lower rate of hypertension and diabetes). Among baseline untreated, average age=77.1±7.0, 55% female, education=14.7±3.8 years, MMSE=24.4±4.7. 51% AD. The proportion of participants with CDR=0.5, 1, 2 was 66%, 25%, and 6% respectively. 47% were referred by a clinical professional. Average follow‐up=3.9±2.2 years. 83% had a spouse/partner or child as co‐participant. Etiology remained AD for 85% of follow‐up visits. Any new AChEI treatment during follow‐up was lower among Blacks (33.7%) and Hispanics (41.4%) compared to whites (45.8%) (p<0.001). After controlling for participant characteristics, adjusted odds of any new AChEI treatment remained lower for Blacks (OR=0.707±0.068) and Hispanics (OR=0.813±0.083, both p<0.05) compared to whites. Unadjusted differences in persistence of treatment were not statistically significant (13.6% intermittent, 28,8% persistence, 57.6% always treated). However, adjusted differences in persistence of treatment was significantly lower for Blacks (OR=0.827±0.090) and Hispanics (OR=0.785±0.081, both p<0.05) compared to whites.ConclusionRacial/ethnic minorities had lower rates of AChEI treatment at study enrollment. Disparities in AChEI treatment persisted even though individuals were followed in ADCs over time and remained significant after adjusting for clinical and demographic variables.