Abstract Details

Title Racial Disparities in Dementia and Parkinson’s Disease Incidence, Healthcare Utilization, and Outcomes among Medicare Beneficiaries

Topic Health Care Disparities

Presentation(s) S28 - Health Care Disparities (1:36 PM-1:48 PM)

Poster/Presentation
Number 004

Objective

To investigate racial disparities in neurodegenerative disease (NDD; defined as any form of dementia or Parkinson’s disease [PD]) incidence, healthcare utilization, and outcomes using data from a 100% sample of Medicare beneficiaries in North and South Carolina.

Background

A large body of literature suggests there are racial disparities in incidence and outcomes for NDD. However, it is not clear what structural factors influence these disparities or how contemporary care patterns differ by race.

Design/Methods

We evaluated racial disparities in NDD incidence, healthcare utilization, and outcomes using 100% Medicare fee-for-service claims from beneficiaries in North and South Carolina. We identified patients with incident and prevalent NDD based on diagnosis codes and prescription medications. We used multivariable Cox regression models adjusting for age, sex, Medicaid dual eligibility, rural location, state, medical comorbidities, and county-level availability of healthcare resources to estimate adjusted associations.

Results Our analysis included 520,256 unique beneficiaries with NDD. Black beneficiaries had a significantly higher incidence of NDD per 100 person-years compared to White beneficiaries in both 2014 (4.03 vs 3.61, p<0.0001) and 2017 (3.05 vs 3.00, p<0.0001). Compared with White beneficiaries, Black beneficiaries had a higher risk of all-cause hospitalization (HR = 1.04 [1.01, 1.06]) but were less likely to receive memory/physical therapy (HR = 0.62 [0.55, 0.69]) or hospice services (HR = 0.86 [0.82, 0.91]) after adjustment. Compared with White beneficiaries, Black beneficiaries with dementia were less likely to receive dementia medications (HR= 0.92 [0.88, 0.96]), and Black beneficiaries with PD were less likely to receive PD medications (HR = 0.81 [0.72, 0.92]). Finally, Black beneficiaries on average spent more days in skilled nursing facilities than White beneficiaries (RR = 1.08 [1.02, 1.14]).

Conclusions

Substantial racial disparities exist in neurodegenerative disease treatment patterns and outcomes. Multi-level approaches to promote health equity in the treatment of dementia and Parkinson’s disease are needed.

Authors/Disclosures
Jay B. Lusk PRESENTER	Mr. Lusk has received research support from American Heart Association.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Margarethe Goetz, PhD, PA (Duke University)	Dr. Goetz has nothing to disclose.
	No disclosure on file
Sneha Mantri, MD, MS, FAAN	Dr. Mantri has received personal compensation for serving as an employee of Parkinson's Foundation. Dr. Mantri has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. The institution of Dr. Mantri has received research support from The Michael J Fox Foundation for Parkinson Research.
	No disclosure on file
Richard J. O'Brien, MD (Duke)	Dr. O'Brien has nothing to disclose.
	No disclosure on file

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