Kim Seoyoun, Yoon Hyunwoo, Jang Yuri
Department of Sociology, Texas State University, San Marcos, TX 78666, USA.
Department of Social Welfare, Institute of Social Welfare, Kongju National University, Gongju-si 32588, Republic of Korea.
Behav Sci (Basel). 2023 Nov 20;13(11):955. doi: 10.3390/bs13110955.
Because subjective cognitive decline (SCD) manifests before the clinical and irreversible onset of dementia, efforts to address SCD are imperative for the early identification and prevention of dementia. For people who actually experience SCD, having a usual source of care may be an important catalyst for addressing memory issues. This study investigates the relationship between having a usual source of care and the discussion of SCD with healthcare providers, while taking into account racial and ethnic differences. The pooled 2019-2020 Behavioral Risk Factor Surveillance System (BRFSS) from 47 states in the U.S. was used. The sample included 7900 individuals aged 50 and older who reported significant cognitive decline. Using logistic regression with state-level clustering, we found that those with a usual source of healthcare were almost twice as more likely to discuss memory loss with a healthcare provider. In order to test for the multiplicative effects, we included an interaction term between each race category and having a primary care provider (PCP). There was a significant interaction effect between Hispanic ethnicity and having a PCP (OR = 0.25, < 0.05). While non-Hispanic respondents who had a PCP had a higher probability of discussing memory issues with a healthcare provider (42% vs. 25%), Hispanic respondents with a PCP were less likely to discuss their memory loss with a healthcare provider (36% vs. 49%). The study adds to the growing literature on the vital role of the primary care service in provision of service to those with cognitive decline, while revealing ethnic disparity in memory-loss-related communication with healthcare providers in a primary care setting.
由于主观认知下降（SCD）在痴呆症临床发作且不可逆转之前就已出现，因此应对SCD对于早期识别和预防痴呆症至关重要。对于实际经历SCD的人来说，有一个常规的护理来源可能是解决记忆问题的重要催化剂。本研究调查了有常规护理来源与与医疗服务提供者讨论SCD之间的关系，同时考虑了种族和民族差异。使用了来自美国47个州的2019 - 2020年行为风险因素监测系统（BRFSS）汇总数据。样本包括7900名50岁及以上报告有明显认知下降的个体。通过使用具有州级聚类的逻辑回归分析，我们发现有常规医疗保健来源的人与医疗服务提供者讨论记忆丧失问题的可能性几乎是其他人的两倍。为了测试相乘效应，我们纳入了每个种族类别与有初级保健提供者（PCP）之间的交互项。西班牙裔种族与有PCP之间存在显著的交互效应（OR = 0.25，P < 0.05）。虽然有PCP的非西班牙裔受访者与医疗服务提供者讨论记忆问题的概率更高（42%对25%），但有PCP的西班牙裔受访者与医疗服务提供者讨论记忆丧失问题的可能性较小（36%对49%）。该研究进一步丰富了关于初级保健服务在为认知下降者提供服务方面的重要作用的文献，同时揭示了在初级保健环境中与医疗服务提供者进行记忆丧失相关沟通方面的种族差异。
