Racial Disparities in Dementia and Parkinson’s Disease Incidence, Healthcare Utilization, and Outcomes among Medicare Beneficiaries
Jay Lusk1, Cassie Ford2, Amy G Clark2, Melissa A Greiner2, Kim Johnson3,4, Margerethe Goetz3, Brystana G Kaufman2, Sneha Mantri3, Ying Xian5,6, Richard O'Brien3, Emily O'Brien2,3
1School of Medicine and Fuqua School of Business, 2Department of Population Health Sciences, 3Department of Neurology, 4Department of Psychiatry and Behavioral Sciences, Duke University, 5Department of Neurology, 6Department of Population and Data Science, University of Texas-Southwestern
Objective:

To investigate racial disparities in neurodegenerative disease (NDD; defined as any form of dementia or Parkinson’s disease [PD]) incidence, healthcare utilization, and outcomes using data from a 100% sample of Medicare beneficiaries in North and South Carolina.

Background:

A large body of literature suggests there are racial disparities in incidence and outcomes for NDD. However, it is not clear what structural factors influence these disparities or how contemporary care patterns differ by race.

Design/Methods:

We evaluated racial disparities in NDD incidence, healthcare utilization, and outcomes using 100% Medicare fee-for-service claims from beneficiaries in North and South Carolina. We identified patients with incident and prevalent NDD based on diagnosis codes and prescription medications. We used multivariable Cox regression models adjusting for age, sex, Medicaid dual eligibility, rural location, state, medical comorbidities, and county-level availability of healthcare resources to estimate adjusted associations.

Results:
Our analysis included 520,256 unique beneficiaries with NDD. Black beneficiaries had a significantly higher incidence of NDD per 100 person-years compared to White beneficiaries in both 2014 (4.03 vs 3.61, p<0.0001) and 2017 (3.05 vs 3.00, p<0.0001). Compared with White beneficiaries, Black beneficiaries had a higher risk of all-cause hospitalization (HR = 1.04 [1.01, 1.06]) but were less likely to receive memory/physical therapy (HR = 0.62 [0.55, 0.69]) or hospice services (HR = 0.86 [0.82, 0.91]) after adjustment. Compared with White beneficiaries, Black beneficiaries with dementia were less likely to receive dementia medications (HR= 0.92 [0.88, 0.96]), and Black beneficiaries with PD were less likely to receive PD medications (HR = 0.81 [0.72, 0.92]). Finally, Black beneficiaries on average spent more days in skilled nursing facilities than White beneficiaries (RR = 1.08 [1.02, 1.14]).
Conclusions:

Substantial racial disparities exist in neurodegenerative disease treatment patterns and outcomes. Multi-level approaches to promote health equity in the treatment of dementia and Parkinson’s disease are needed.