Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Alzheimer's Disease Center, University of Alabama at Birmingham, Birmingham, AL, USA.
J Alzheimers Dis. 2021;83(4):1753-1765. doi: 10.3233/JAD-210240.
Use of specialists and recommended drugs has beneficial effects for older adults living with Alzheimer's disease and related dementia (ADRD). Gaps in care may exist for minorities, e.g., Blacks, and especially in the United States (U.S.) Deep South (DS), a poor U.S. region with rising ADRD cases and minority overrepresentation. Currently, we have little understanding of ADRD care utilization in diverse populations in this region and elsewhere in the U.S. (non-DS), and the factors that adversely impact it.
To examine utilization of specialists and ADRD drugs (outcomes) in racial/ethnic groups of older adults with ADRD and the personal or context-level factors affecting these outcomes in DS and non-DS.
We obtained outcomes and personal-level covariates from claims for 127,512 Medicare beneficiaries with ADRD in 2013-2015, and combined county-level data in exploratory factor analysis to define context-level covariates. Adjusted analyses tested significant association of outcomes with Black/White race and other factors in DS and non-DS.
Across racial/ethnic groups, 33%-43% in DS and 43%-50% in non-DS used specialists; 47%-55% in DS and 41%-48% in non-DS used ADRD drugs. In adjusted analyses, differences between Blacks and Whites were not significant. Vascular dementia, comorbidities, poverty, and context-level factor "Availability of Medical Resources" were associated with specialist use; Alzheimer's disease and senile dementia, comorbidities, and specialist use were associated with drug use. In non-DS only, other individual, context-level covariates were associated with the outcomes.
We did not observe significant gaps in ADRD care in DS and non-DS; however, research should further examine determinants of low specialist and drug use in these regions.
使用专科医生和推荐药物对患有阿尔茨海默病和相关痴呆症（ADRD）的老年患者有益。少数族裔（如黑人）的护理可能存在差距，尤其是在美国（美国）深南部（DS），这是一个贫困地区，ADRD 病例和少数族裔比例上升。目前，我们对该地区和美国其他地区（非 DS）不同人群的 ADRD 护理利用情况以及对其产生不利影响的因素知之甚少。
检查 DS 和非 DS 中患有 ADRD 的老年患者的种族/族裔群体中专科医生和 ADRD 药物的使用情况（结果），以及影响这些结果的个人或环境因素。
我们从 2013 年至 2015 年的 127512 名患有 ADRD 的 Medicare 受益人的索赔中获得了结果和个人层面的协变量，并在探索性因素分析中结合了县级数据来定义环境层面的协变量。调整后的分析测试了结果与黑人/白人种族和 DS 及非 DS 中其他因素的显著关联。
在所有种族/族裔群体中，DS 中的 33%-43%和非 DS 中的 43%-50%使用了专科医生；DS 中的 47%-55%和非 DS 中的 41%-48%使用了 ADRD 药物。在调整后的分析中，黑人与白人之间的差异不显著。血管性痴呆、合并症、贫困和环境层面的因素“医疗资源的可获得性”与专科医生的使用相关；而阿尔茨海默病和老年性痴呆、合并症和专科医生的使用与药物的使用相关。仅在非 DS 中，其他个人和环境层面的协变量与结果相关。
我们没有观察到 DS 和非 DS 中 ADRD 护理存在显著差距；然而，研究应进一步探讨这些地区专科医生和药物使用率低的决定因素。
