Journal
ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS
Volume 5, Issue 1, Pages 891-898Publisher
WILEY
DOI: 10.1016/j.trci.2019.11.008
Keywords
Dementia; Alzheimer's disease; Clinical diagnosis; Disparities; Health and retirement study
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IntroductionSystematic disparities in misdiagnosis of dementia across racial/ethnic groups have implications for health disparities. We compared the risk of dementia under- and overdiagnosis in clinical settings across racial/ethnic groups from 2000 to2010. MethodsWe linked fee-for-service Medicare claims to participants aged >= 70 from the nationally representative Health and Retirement Study. We classified dementia status using an algorithm with similar sensitivity and specificity across racial/ethnic groups and assigned clinical dementia diagnosis status using ICD-9-CM codes from Medicare claims. Multinomial logit models were used to estimate relative risks of clinical under- and overdiagnosis between groups and over time. ResultsNon-Hispanic blacks had roughly double the risk of underdiagnosis as non-Hispanic whites. While primary analyses suggested a shrinking disparity over time, this was not robust to sensitivity analyses or adjustment for covariates. Risk of overdiagnosis increased over time in both groups. DiscussionOur results suggest that efforts to reduce racial disparities in underdiagnosis are warranted.
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