Olchanski Natalia, Zhu Yingying, Liang Lichen, Cohen Joshua T, Faul Jessica D, Fillit Howard M, Freund Karen M, Lin Pei-Jung
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 Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA.
J Am Geriatr Soc. 2024 Apr;72(4):1223-1233. doi: 10.1111/jgs.18822. Epub 2024 Mar 20.
Research on racial and ethnic disparities in costs of care during the course of dementia is sparse. We analyzed Medicare expenditures for beneficiaries with dementia to identify when during the course of care costs are the highest and whether they differ by race and ethnicity.
We analyzed data from the 2000-2016 Health and Retirement Study (HRS) linked with corresponding Medicare claims to estimate total Medicare expenditures for four phases: (1) the year before a dementia diagnosis, (2) the first year following a dementia diagnosis, (3) ongoing care for dementia after the first year, and (4) the last year of life. We estimated each patient's phase-specific and disease course Medicare expenditures by using a race-specific survival model and monthly expenditures adjusted for patient characteristics. We investigated healthcare utilization by service type across races/ethnicities and phases of care.
Adjusted mean total Medicare expenditures for non-Hispanic (NH) Black ($165,730) and Hispanic beneficiaries with dementia ($160,442) exceeded corresponding expenditures for NH Whites ($136,326). In the year preceding and immediately following initial dementia diagnosis, mean Medicare expenditures for NH Blacks ($26,337 and $20,429) exceeded expenditures for Hispanics and NH Whites ($21,399-23,176 and 17,182-18,244). The last year of life was responsible for the greatest cost contribution: $51,294 (NH Blacks), $47,469 (Hispanics), and $39,499 (NH Whites). These differences were driven by greater use of high-cost services (e.g., emergency department, inpatient and intensive care), especially during the last year of life.
NH Black and Hispanic beneficiaries with dementia had higher disease course Medicare expenditures than NH Whites. Expenditures were highest for NH Black beneficiaries in every phase of care. Further research should address mechanisms of such disparities and identify methods to improve communication, shared decision-making, and access to appropriate services for all populations.
关于痴呆症病程中医疗费用的种族和民族差异的研究较少。我们分析了痴呆症受益人的医疗保险支出，以确定在护理过程中费用最高的阶段，以及这些费用是否因种族和民族而异。
我们分析了2000 - 2016年健康与退休研究（HRS）的数据，并将其与相应的医疗保险索赔数据相链接，以估计四个阶段的医疗保险总支出：（1）痴呆症诊断前一年；（2）痴呆症诊断后的第一年；（3）第一年之后的痴呆症持续护理阶段；（4）生命的最后一年。我们使用特定种族的生存模型和根据患者特征调整的每月支出，估计了每位患者特定阶段和疾病病程的医疗保险支出。我们调查了不同种族/民族以及护理阶段中各类服务的医疗保健利用率。
患有痴呆症的非西班牙裔黑人（165,730美元）和西班牙裔受益人的调整后平均医疗保险总支出超过了非西班牙裔白人（136,326美元）的相应支出。在初次痴呆症诊断前一年和诊断后紧接着的一年中，非西班牙裔黑人的平均医疗保险支出（26,337美元和20,429美元）超过了西班牙裔和非西班牙裔白人（21,399 - 23,176美元和17,182 - 18,244美元）。生命的最后一年费用贡献最大：非西班牙裔黑人51,294美元，西班牙裔47,469美元，非西班牙裔白人39,499美元。这些差异是由于更多地使用了高成本服务（如急诊科、住院和重症监护），尤其是在生命的最后一年。
患有痴呆症的非西班牙裔黑人和西班牙裔受益人在疾病病程中的医疗保险支出高于非西班牙裔白人。在护理的每个阶段，非西班牙裔黑人受益人的支出最高。进一步的研究应探讨这种差异的机制，并确定改善沟通、共同决策以及为所有人群提供适当服务的方法。
