2023 American Academy of Neurology Abstract Website

Objective:

Determine if the Area Deprivation Index (ADI) influences the evaluation and likelihood of receiving an etiological diagnosis of dementia in Virginia

Background:

Inequities in diagnosis and management of dementias disproportionally affect historically marginalized populations. The ADI provides a multidimensional metric of disadvantage by incorporating measures on education, housing, employment, and poverty.

Design/Methods:

We obtained UVA Health Center Electronic Medical Record data of all patients, diagnosed for the first time with dementia (2018-2021). These diagnoses were categorized as either “general” (e.g., dementia non-specified) or “disease-specific” (e.g., Alzheimer’s disease), based on the ICD-10 code used. We defined “adequate evaluation” as CT or MRI scan and vitamin B12+TSH levels. We divided the 2019 ADI into tertiles, with ~4,600 patients/tertile. A logistic regression was performed in R, adjusting for patient demographics, census tract population density, and patient address as a spatial effect.

Results:

14,292 patients were diagnosed with dementia over 2018-2021 (age 76.5+/-10.3 years; 53.1% female), with 96.3% linked to a census-tract-level ADI. Only 6.4% of patients had an adequate evaluation (15.5% adequate labs, 21.9% adequate imaging) and 30.1% received a disease-specific diagnosis. Men had lower odds of receiving a disease-specific diagnosis (OR = 0.72; p<0.001), adjusted for all other factors. Patients were increasingly likely to receive disease-specific diagnoses from ages 50 - 90, with decreasing likelihood after age 90. Higher ADI (greater deprivation) increased the likelihood of undergoing adequate evaluation (tertile 2vs1 OR: 1.21, p=0.053; tertile 3vs1 OR: 1.29, p=0.036) but decreased the likelihood of receiving a disease-specific diagnosis (tertile 2vs1 OR: 0.89, p=0.043; tertile 3vs1 OR: 0.97, p=0.616).

Conclusions:

ADI had an opposite effect on evaluation and disease-specific diagnoses. Those in more disadvantaged neighborhoods were more likely to receive an adequate evaluation, but less likely to receive a disease-specific diagnosis.This finding may explain the lower rates of recruitment of historically marginalized populations into clinical trials.