AbstractBackgroundStudies have shown that mis‐identification of dementia in Medicare claims is quite common. We extend the literature by examining potential race/ethnic disparities in mis‐identification of dementia in Medicare claims in a diverse cohort of older adults who underwent careful clinical assessment.MethodParticipants were enrolled the Washington Heights‐Inwood Columbia Aging Project (WHICAP), a multiethnic, population‐based, prospective study of cognitive aging in which dementia status is assessed using a rigorous clinical protocol. The current study included 1,178 participants clinically diagnosed with dementia and 3,048 never diagnosed with dementia. ICD‐9‐CM diagnosis codes in all available Medicare claims (1999‐2019) were compared to clinical dementia diagnosis, and categorized into 3 mutually exclusive groups: (1) congruent identification, (2) over‐identification (no clinical dementia, claims‐identified dementia), and (3) under‐identification (clinical dementia, no claims‐identified dementia) during the study period. Race (White, African American/Black, Other) and ethnicity (Hispanic/Latinx, non‐Hispanic/Latinx) were self‐reported. Multinomial logistic regression model was used to examine the relationship between race/ethnicity and congruency of dementia identification after controlling for clinical (cognition, function, comorbidities) and demographic characteristics (age, sex, education), and inpatient and outpatient utilization. Estimated average marginal effects are reported.ResultThe study included 1,520 White, 1,333 African American/Black, and 1,373 participants of other races. 1,985 participants self‐identified as Hispanic, 2,241 non‐Hispanic. Among participants clinically diagnosed with dementia, the proportion who were accurately identified with dementia in Medicare claims were 83.2%, 77.8%, and 73.2% in White, African American/Black, and other races, respectively; 75.9% and 79.7% in Hispanics and non‐Hispanics, respectively. Among participants clinically diagnosed without dementia, the proportion of participants who were accurately identified without dementia in Medicare claims were: 86.1%, 87.3%, and 82.3% in White, African American/Black, and other races, respectively; 82.4% and 87.5% in Hispanics and non‐Hispanics, respectively. After controlling for participant characteristics, multinomial logistics regression results show the probability of over‐identification with dementia was 2.2% higher for African American/Black participants than White (p = 0.05) and 2.7% higher for Hispanic participants than non‐Hispanics (p = 0.03). Differences in under‐identification by race/ethnicity were no longer statistically significant.ConclusionAfrican American/Black and Hispanic participants were more likely to be over‐identified with dementia in Medicare claims.
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