Racial and Ethnic Differences in Initiation and Discontinuation of Antidementia Drugs by Medicare Beneficiaries

Thorpe, Carolyn T.; Fowler, Nicole R.; Harrigan, Katherine; Zhao, Xinhua; Kang, Yihuang; Hanlon, Joseph T.; Gellad, Walid F.; Schleiden, Loren J.; Thorpe, Joshua M.

doi:10.1111/jgs.14403

Cited by 36 publications

(43 citation statements)

References 45 publications

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“…These include a large USA study, in which people from Black and Hispanic ethnic groups were more likely to discontinue antidementia medication, relative to people from White ethnic groups. 9 In a large Australian care homes study, antidementia medication was initiated earlier in residents who spoke English as a first language. 8 There are international variations in subsidisation of anti-dementia medications.…”

Section: Discussionmentioning

confidence: 99%

“…7 Large studies in Australia and the USA have concluded that minority ethnic groups access anti-dementia treatments later 8 or are more likely to discontinue. 9 We defined good quality mental healthcare as: access to cholinesterase inhibitors or memantine (anti-dementia drugs) to treat dementia symptoms where they are indicated; low antipsychotic, hypnotic, and anxiolytic medication use, due to the associated risks of cognitive decline, falls, cerebrovascular events and death; 10 and low use of anticholinergic drugs, which are associated with worse cognition and quality of life. 11 The Choosing Wisely recommendations and other guidelines advocate limiting initiation and duration of antipsychotic prescribing for behavioural and psychological symptoms of dementia (BPSD) as far as possible.…”

Section: Introductionmentioning

confidence: 99%

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<p>Differences in Psychotropic Drug Prescribing Between Ethnic Groups of People with Dementia in the United Kingdom</p>

Jones¹,

Petersen²,

Walters³

et al. 2020

CLEP

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Purpose: To test hypotheses that minority ethnic people with dementia in the UK receive fewer anti-dementia drugs and more psychotropic and anticholinergic drugs associated with harms. Patients and Methods: We analyzed UK primary care electronic health records from The Health Improvement Network (THIN) database (2014-2016), comparing psychotropic drug prescribing initiation and duration between people with dementia from White, Black, and Asian ethnic groups. We repeated analyses in people (aged 50+) without dementia, to explore whether any differences found reflected prescribing patterns in the general older population, or were specific to dementia. Results: We included 53,718 people with and 1,648,889 people without dementia. Among people with dementia, compared to White ethnic groups, Asian people were less likely to be prescribed anti-dementia drugs when they were potentially indicated (adjusted prevalence rate ratio 0.86 (95% Confidence Interval 0.76-0.98)), and received them for on average 15 days/year less. Compared to White groups, Asian and Black individuals with dementia were no more likely to take an antipsychotic drug, but those that had were prescribed them for 17 and 27 days/year more, respectively (190.8 (179.6-199.1) and 200.7 (191.1-206.5) days). Black people were less likely to be prescribed anxiolytics/hypnotics (0.60 (0.44-0.8)), but the duration these drugs were prescribed was similar across ethnic groups. Asian people were more likely to be prescribed anticholinergic drugs (1.43 (1.19-1.73)), in analyses unadjusted for cardiovascular comorbidities. Among people without dementia, those in the Asian and Black ethnic groups were less likely to be prescribed psychotropic drugs, relative to people from White groups. Conclusion: Among people with dementia, Asian groups received less potentially beneficial symptomatic treatments, and Asian and Black groups were prescribed antipsychotic drugs for longer than White ethnic groups. Our findings may indicate care inequalities.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

<p>Differences in Psychotropic Drug Prescribing Between Ethnic Groups of People with Dementia in the United Kingdom</p>

Jones¹,

Petersen²,

Walters³

et al. 2020

CLEP

View full text Add to dashboard Cite

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“…This variable was developed by the CMS based on valid disease classification and procedure codes from Medicare claims 15 and has been used extensively in literature. 14,[16][17][18][19][20][21][22][23][24][25][26][27][28] Previous studies demonstrate a 95% specificity using Medicare claims and a 79% sensitivity among continuous enrollees in Medicare fee-or-service using this definition. 29,30 Then, we selected those who filled at least 1 prescription for an antidementia drug (donepezil, rivastigmine, galantamine, or memantine) after the AD diagnosis (n ¼ 73 642).…”

Section: Data Source and Study Populationmentioning

confidence: 93%

Risk Factors for Cardiovascular Events in Patients on Antidementia Medications

Stevenson

Zhang

et al. 2020

Am J Alzheimers Dis Other Demen

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Objective: To identify characteristics associated with an increased risk of cardiovascular events in patients diagnosed with Alzheimer disease (AD) and treated with antidementia medications. Methods: Demographics, diagnoses, and medication usage of 30 433 Medicare patients were analyzed using 2006 to 2013 claims data and a combined model of screening, ranking and stepwise logistic regressions to evaluate factors associated with composite outcomes of 6 cardiovascular events. Results: Incidence rate of at least 1 cardiovascular event was 25.1%. Fifty-five factors were identified from the 10 381 candidate variables by the combined model with a c-statistic of 67% and an accuracy of 75%. Factors associated with increased risk of cardiovascular events include history of heart rhythm disorders, alteration of consciousness (odds ratio [OR]: 1.25; 95% confidence interval [CI]: 1.14-1.36), and usage of β-blockers (OR: 1.19; 95% CI: 1.13-1.27). Conclusions: Clinicians should consider the increased risk of cardiovascular events in patients with AD with heart rhythm disorders and on β-blockers.

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“…Not recognizing early changes in cognitive function as a sign of ADRD may contribute to Hispanics experiencing declines in memory for a longer period of time before being diagnosed with ADRD [19] and having more severe symptoms when ADRD is diagnosed compared to non-Hispanic whites [20,21]. Some [22], but not all [23] studies have reported that Hispanics who have been diagnosed with ADRD are less likely than non-Hispanic whites to be taking medications for ADRD symptoms. The more severe ADRD symptoms and less treatment of symptoms among older Hispanics may contribute to increased healthcare utilization in this population.…”

Section: Introductionmentioning

confidence: 99%

Healthcare utilization of Mexican-American Medicare beneficiaries with and without Alzheimer’s disease and related dementias

Downer¹,

Snih²,

Raji³

et al. 2020

PLoS ONE

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Background Older adults with Alzheimer's disease and related dementias (ADRD) are high-risk to experience hospitalizations and emergency room (ER) admissions. Mexican-Americans have a high prevalence of ADRD, but there is limited information on the healthcare use of older Mexican-Americans with ADRD. We used data from a cohort of older Mexican-Americans that has been linked with Medicare files to investigate differences in hospitalizations, ER admissions, and physician visits according to ADRD diagnosis. We also identify sociodemographic, health, and functional characteristics that may contribute to differences in healthcare utilization between Mexican-American Medicare beneficiaries with and without an ADRD diagnosis. Methods and findings Data came from the Hispanic Established Populations for the Epidemiological Study of the Elderly that has been linked with Medicare Master Beneficiary Summary Files, Medicare Provider Analysis and Review files, Outpatient Standard Analytic files, and Carrier files. The final analytic sample included 1048 participants. Participants were followed for two years (eight quarters) after their survey interview. Generalized estimating equations were used to estimate the probability for one or more hospitalizations, ER admissions, and physician visits at each quarter. ADRD was associated with higher odds for hospitalizations (OR = 1.65, 95%CI = 1.29-2.11) and ER admissions (OR = 1.57, 95%CI = 1.23-1.94) but not physician visits (OR = 1.23, 95%CI = 0.91-1.67). The odds for hospitalizations (OR = 1.24, 95%CI = 0.97-1.60) and ER admissions (OR = 1.27, 95%CI = 1.01-1.59) were reduced after controlling for limitations in activities of daily living and comorbidities.

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Racial and Ethnic Differences in Initiation and Discontinuation of Antidementia Drugs by Medicare Beneficiaries

Cited by 36 publications

References 45 publications

<p>Differences in Psychotropic Drug Prescribing Between Ethnic Groups of People with Dementia in the United Kingdom</p>

<p>Differences in Psychotropic Drug Prescribing Between Ethnic Groups of People with Dementia in the United Kingdom</p>

Risk Factors for Cardiovascular Events in Patients on Antidementia Medications

Healthcare utilization of Mexican-American Medicare beneficiaries with and without Alzheimer’s disease and related dementias

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