Racial disparities and temporal trends in dementia misdiagnosis risk in the United States
Alzheimer's and Dementia: Translational Research and Clinical Interventions
Alzheimer's disease; Clinical diagnosis; Dementia; Disparities; Health and retirement study
© 2019 The Authors Introduction: Systematic 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 to 2010. Methods: We 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. Results: Non-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. Discussion: Our results suggest that efforts to reduce racial disparities in underdiagnosis are warranted.
Gianattasio, K., Prather, C., Glymour, M., Ciarleglio, A., & Power, M. (2019). Racial disparities and temporal trends in dementia misdiagnosis risk in the United States. Alzheimer's and Dementia: Translational Research and Clinical Interventions, 5 (). http://dx.doi.org/10.1016/j.trci.2019.11.008