Socioeconomic inequalities in dementia diagnostic process and medication prescription: Experience from the Swedish Dementia Registry

Abstract

AbstractBackgroundLower socioeconomic position (SEP) was associated with higher risk of morbidity and mortality. However, the influence of SEP on diagnosis and medication use in dementia is understudied. Our study aimed to explore the impact of patients’ SEP on dementia diagnostic process and medications.MethodIn this longitudinal cohort study, data from 74,414 dementia patients registered in the Swedish Dementia Registry (2007‐2018) were linked with the Swedish Longitudinal Integrated Database for Health Insurance and Labor Market Studies (2006‐2017). SEP was expressed through education and disposable individual income. Outcomes included performance of the dementia diagnostic examinations and prescription of anti‐dementia drugs. The complete basic diagnostic work‐up comprising blood testing, neuroimaging, clock‐test and Mini‐Mental State Examination (MMSE) was suggested by the diagnostic guidelines for dementia from the Swedish National Board of Health and Welfare and was the main study outcome.ResultIn comparison with patients who completed compulsory education < 9 years, patients with university ≥3 years had higher probability of receiving the basic diagnostic work‐up (odds ratio (OR) 1.19; 95% confidence interval (CI) 1.10‐1.29), clock test (OR 1.12; 95%CI 1.02‐1.24) and CT‐MRI (OR 1.23; 95%CI 1.09‐1.39). Compared with people in the lowest income quintile, patients in the highest income quintile presented higher chance of receiving the basic diagnostic work‐up (OR 1.35; 95%CI 1.26‐1.46), clock test (OR 1.40; 95%CI 1.28‐1.52), blood analysis (OR 1.21; 95%CI 1.06‐1.39), MMSE (OR 1.47; 95%CI 1.26‐1.70) and CT‐MRI (OR 1.30; 95%CI 1.18‐1.44). Higher SEP was significantly associated with higher chance of being diagnosed at a specialist care. People with higher income were more likely to receive a specific dementia diagnosis, as opposed to “unspecified” dementia. SEP presented no association with prescription of anti‐dementia medication, except for the association between education and the use of memantine.ConclusionInequalities in dementia diagnostic process and prescription of anti‐dementia medications occur among people with different education or income levels. Income was more decisive than education in the relation to dementia diagnostic process.