Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA.
Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.
Alzheimers Dement. 2023 Apr;19(4):1184-1193. doi: 10.1002/alz.12753. Epub 2022 Aug 8.
We examined racial and ethnic differences in medication use for a representative US population of patients with Alzheimer's disease and related dementias (ADRD).
We examined cholinesterase inhibitors and memantine initiation, non-adherence, and discontinuation by race and ethnicity, using data from the 2000-2016 Health and Retirement Study linked with Medicare and Medicaid claims.
Among newly diagnosed ADRD patients (n = 1299), 26% filled an ADRD prescription ≤90 days and 36% ≤365 days after diagnosis. Among individuals initiating ADRD-targeted treatment (n = 1343), 44% were non-adherent and 24% discontinued the medication during the year after treatment initiation. Non-Hispanic Blacks were more likely than Whites to not adhere to ADRD medication therapy (odds ratio: 1.50 [95% confidence interval: 1.07-2.09]).
Initiation of ADRD-targeted medications did not vary by ethnoracial group, but non-Hispanic Blacks had lower adherence than Whites. ADRD medication non-adherence and discontinuation were substantial and may relate to cost and access to care.
Initiation of anti-dementia medications among newly diagnosed Alzheimer's disease and related dementias (ADRD) patients was low in all ethnoracial groups. ADRD medication non-adherence and discontinuation were substantial and may relate to cost and access to care. Compared to Whites, Blacks and Hispanics had lower use, poorer treatment adherence, and more frequent discontinuation of ADRD medication, but when controlling for disease severity and socioeconomic factors, racial disparities diminish. Our findings demonstrate the importance of adjusting for socioeconomic characteristics and disease severity when studying medication use and adherence in ADRD patients.
我们研究了具有代表性的美国阿尔茨海默病和相关痴呆症（ADRD）患者人群中药物使用的种族和民族差异。
我们利用 2000 年至 2016 年健康与退休研究的数据，该数据与医疗保险和医疗补助索赔相关联，检查了胆碱酯酶抑制剂和美金刚的起始、不依从和停药情况，按种族和民族进行了分析。
在新诊断的 ADRD 患者（n=1299）中，26%的患者在诊断后 90 天内开了 ADRD 处方，36%的患者在诊断后 365 天内开了 ADRD 处方。在开始 ADRD 靶向治疗的个体中（n=1343），44%的患者不依从，24%的患者在治疗开始后的一年内停止用药。与白人相比，非西班牙裔黑人更有可能不遵守 ADRD 药物治疗（优势比：1.50 [95%置信区间：1.07-2.09]）。
ADRD 靶向药物的起始使用不因种族群体而异，但非西班牙裔黑人的依从性低于白人。ADRD 药物的不依从和停药率相当高，这可能与成本和获得医疗保健有关。
在所有种族群体中，新诊断的阿尔茨海默病和相关痴呆症（ADRD）患者开始使用抗痴呆药物的比例都很低。ADRD 药物的不依从和停药率相当高，这可能与成本和获得医疗保健有关。与白人相比，黑人及西班牙裔人群使用 ADRD 药物的比例较低、治疗依从性较差、停药的频率更高，但在控制疾病严重程度和社会经济因素后，种族差异有所缩小。我们的研究结果表明，在研究 ADRD 患者的药物使用和依从性时，调整社会经济特征和疾病严重程度非常重要。
