Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston.
Sealy Center on Aging, University of Texas Medical Branch, Galveston.
J Gerontol A Biol Sci Med Sci. 2021 Feb 25;76(3):534-542. doi: 10.1093/gerona/glaa236.
Evidence from predominantly non-Hispanic White cohorts indicates health care utilization increases before Alzheimer's disease and related dementias (ADRD) is diagnosed. We investigated trends in health care utilization by Mexican American Medicare beneficiaries before and after an incident diagnosis of ADRD.
Data came from the Hispanic Established Populations for the Epidemiological Study of the Elderly that has been linked with Medicare claims files from 1999 to 2016 (n = 558 matched cases and controls). Piecewise regression and generalized linear mixed models were used to compare the quarterly trends in any (ie, one or more) hospitalizations, emergency room (ER) admissions, and physician visits for 1 year before and 1 year after ADRD diagnosis.
The piecewise regression models showed that the per-quarter odds for any hospitalizations (odds ratio [OR] = 1.62, 95% CI = 1.43-1.84) and any ER admissions (OR = 1.40, 95% CI = 1.27-1.54) increased before ADRD was diagnosed. Compared to participants without ADRD, the percentage of participants with ADRD who experienced any hospitalizations (27.2% vs 14.0%) and any ER admissions (19.0% vs 11.7%) was significantly higher at 1 quarter and 3 quarters before ADRD diagnosis, respectively. The per-quarter odds for any hospitalizations (OR = 0.88, 95% CI = 0.80-0.97) and any ER admissions (OR = 0.89, 95% CI = 0.82-0.97) decreased after ADRD was diagnosed. Trends for any physician visits before or after ADRD diagnosis were not statistically significant.
Older Mexican Americans show an increase in hospitalizations and ER admissions before ADRD is diagnosed, which is followed by a decrease after ADRD diagnosis. These findings support the importance of a timely diagnosis of ADRD for older Mexican Americans.
主要是非西班牙裔白人队列的证据表明，在诊断出阿尔茨海默病及相关痴呆症（ADRD）之前，医疗保健的利用率会增加。我们调查了墨西哥裔美国医疗保险受益人的 ADRD 发病前后医疗保健利用率的趋势。
数据来自西班牙裔老年人流行病学研究的既定人群，该研究已与 1999 年至 2016 年的医疗保险索赔档案相关联（n = 558 例匹配病例和对照）。分段回归和广义线性混合模型用于比较 ADRD 诊断前 1 年和后 1 年每季度任何（即一种或多种）住院、急诊（ER）就诊和医生就诊的趋势。
分段回归模型显示，任何住院治疗的每季度几率（比值比[OR] = 1.62，95%置信区间[CI] = 1.43-1.84）和任何 ER 入院的几率（OR = 1.40，95%CI = 1.27-1.54）在 ADRD 诊断前增加。与没有 ADRD 的参与者相比，在 ADRD 诊断前 1 个季度和 3 个季度，有 ADRD 的参与者经历任何住院治疗（27.2%比 14.0%）和任何 ER 入院（19.0%比 11.7%）的比例明显更高。任何住院治疗（OR = 0.88，95%CI = 0.80-0.97）和任何 ER 入院（OR = 0.89，95%CI = 0.82-0.97）的每季度几率在 ADRD 诊断后降低。ADRD 诊断前后任何医生就诊的趋势没有统计学意义。
老年墨西哥裔美国人在诊断出 ADRD 之前会增加住院和 ER 就诊，之后 ADRD 诊断后会减少。这些发现支持对老年墨西哥裔美国人及时诊断 ADRD 的重要性。
