医疗保险索赔和调查数据中痴呆症的患病率在性别、种族和年龄方面的差异。
Sex, Race, and Age Differences in Prevalence of Dementia in Medicare Claims and Survey Data.
机构信息
Price School of Public Policy & Schaeffer Center, University of Southern California, Los Angeles.
Davis School of Gerontology, University of Southern California, Los Angeles.
出版信息
J Gerontol B Psychol Sci Soc Sci. 2021 Feb 17;76(3):596-606. doi: 10.1093/geronb/gbaa083.
OBJECTIVES
This study provides the first comparison of trends in dementia prevalence in the U.S. population using 3 different dementia ascertainments/data sources: neuropsychological assessment, cognitive tests, and diagnosis codes from Medicare claims.
METHODS
We used data from the nationally representative Health and Retirement Study and Aging, Demographics, and Memory Study, and a 20% random sample of Medicare beneficiaries. We compared dementia prevalence across the 3 sources by race, gender, and age. We estimated trends in dementia prevalence from 2006 to 2013 based on cognitive tests and diagnosis codes utilizing logistic regression.
RESULTS
Dementia prevalence among older adults aged 70 and older in 2004 was 16.6% (neuropsychological assessment), 15.8% (cognitive tests), and 12.2% (diagnosis codes). The difference between dementia prevalence based on cognitive tests and diagnosis codes diminished in 2012 (12.4% and 12.9%, respectively), driven by decreasing rates of cognitive test-based and increasing diagnosis codes-based dementia prevalence. This difference in dementia prevalence between the 2 sources by sex and for age groups 75-79 and 90 and older vanished over time. However, there remained substantial differences across measures in dementia prevalence among blacks and Hispanics (10.9 and 9.8 percentage points, respectively) in 2012.
DISCUSSION
Our results imply that ascertainment of dementia through diagnosis may be improving over time, but gaps across measures among racial/ethnic minorities highlight the need for improved measurement of dementia prevalence in these populations.
目的
本研究首次比较了美国人群中使用 3 种不同的痴呆症确认方法/数据源（神经心理学评估、认知测试和医疗保险索赔中的诊断代码）的痴呆症患病率趋势。
方法
我们使用了全国代表性的健康与退休研究（Health and Retirement Study）和老龄化、人口统计学和记忆研究（Aging, Demographics, and Memory Study）的数据，以及医疗保险受益人的 20%随机样本。我们通过种族、性别和年龄比较了这 3 个来源的痴呆症患病率。我们利用逻辑回归基于认知测试和诊断代码估计了 2006 年至 2013 年期间痴呆症患病率的趋势。
结果
2004 年，70 岁及以上的老年人中痴呆症的患病率为 16.6%（神经心理学评估）、15.8%（认知测试）和 12.2%（诊断代码）。2012 年，基于认知测试和诊断代码的痴呆症患病率差异缩小（分别为 12.4%和 12.9%），原因是认知测试的患病率下降，而诊断代码的患病率上升。在性别方面以及在 75-79 岁和 90 岁及以上年龄组，这两种来源的痴呆症患病率之间的差异随时间而消失。然而，在 2012 年，黑人和西班牙裔人群中，这两种方法之间的痴呆症患病率仍存在显著差异（分别为 10.9 和 9.8 个百分点）。
讨论
我们的结果表明，通过诊断确定痴呆症的方法可能在不断改进，但在种族/族裔少数群体中，各种方法之间仍存在差距，这突出表明需要改进这些人群中痴呆症患病率的测量方法。
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