Health Disparities in Medication Use for the Treatment of Dementia in the Outpatient Setting
Alice Hawkins1, Estevana Isaac2, Parul Agarwal1, Nathalie Jette1, Georges Naasan2
1Department of Neurology, Mount Sinai, Icahn School of Medicine, New York, NY, 2Department of Neurology, Mount Sinai, Icahn School of Medicine, New York, NY, The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Mount Sinai, New York, NY
Objective:
To investigate disparities along racial/ethnic lines regarding the use of medications employed in the outpatient management of dementia.
Background:
The benefits of medications used in the treatment of dementia, such as cholinesterase inhibitors, SSRIs, and antipsychotics, are not equally distributed in society, and there is evidence for disparities in their utilization in nursing homes and hospitals. However, there remains limited data on disparities in their use in the outpatient setting.
Design/Methods:
In this retrospective study, information on demographics (including self-reported race/ethnicity), outpatient medications, and referrals to specialists was collected on all patients with a diagnosis of dementia seen at a multicenter academic healthcare institution. Frequencies for the utilization of five medication classes (cholinesterase inhibitors, NMDA-antagonists, SSRIs, antipsychotics, and benzodiazepines) were compared among patients with different race/ethnicity using Chi-square and logistic regression, controlling for age, sex, primary language, marital status, insurance type, and presence of specialist referrals.
Results:
Black patients with dementia received all five medication classes significantly less frequently than White patients (20.4% vs. 30% for cholinesterase inhibitors, 10.2% vs. 16.7% for NMDA-antagonists, 23.9% vs. 39.9% for SSRIs, 18% vs. 21.7% for antipsychotics, and 17.5% vs. 36.8% for benzodiazepines; p<0.001). A logistic regression controlling for confounders showed that Black patients received all medications significantly less frequently than White patients, that White patients received benzodiazepines significantly more frequently than all racial/ethnic groups, and that Black patients received more referrals to specialists than White patients. Black patients who received neurology consults were prescribed cholinesterase inhibitors and NMDA antagonists comparably to White patients.
Conclusions:
Racial disparities exist in the prescription patterns of all dementia-related medications, with Black patients receiving prescriptions less frequently than White patients in the outpatient setting. Referrals to specialists such as neurologists may decrease these disparities. More research is needed to understand the root cause of such disparities and design programs to eliminate them.