Racial and ethnic patterns and differences in health care expenditures among Medicare beneficiaries with and without cognitive deficits or Alzheimer’s disease and related dementias

Abstract

Background Numerous studies have documented racial and ethnic differences in the prevalence and incidence of Alzheimer’s disease and related dementias (ADRD). Less is known, however, about racial and ethnic differences in health care expenditures among older adults at risk for ADRD (cognitive deficits without ADRD) or with ADRD. In particular, there is limited evidence that racial and ethnic differences in health care expenditures change over the trajectory of ADRD or differ by types of service. Methods We examined racial and ethnic patterns and differences in health care expenditures (total health care expenditures, out-of-pocket expenditures, and six service-specific expenditures) among Medicare beneficiaries without cognitive deficits, those with cognitive deficits without ADRD, and those with ADRD. Using the 1996–2017 Medical Expenditure Panel Survey, we performed multivariable regression models to estimate expenditure differences among racial and ethnic groups without cognitive deficits, those with cognitive deficits without ADRD, and those with ADRD. Models accounted for survey weights and adjusted for various demographic, socioeconomic, and health characteristics. Results Black, Asians, and Latinos without cognitive deficits had lower total health care expenditures than whites without cognitive deficits ($10,236, $9497, $9597, and $11,541, respectively). There were no racial and ethnic differences in total health care expenditures among those with cognitive deficits without ADRD and those with ADRD. Across all three groups, however, Blacks, Asians, and Latinos consistently had lower out-of-pocket expenditures than whites (except for Asians with cognitive deficits without ADRD). Furthermore, service-specific health care expenditures varied by racial and ethnic groups. Conclusions Our study did not find significant racial and ethnic differences in total health care expenditures among Medicare beneficiaries with cognitive deficits and/or ADRD. However, we documented significant differences in out-of-pocket expenditures and service-specific expenditures. We speculated that the differences may be attributable to racial and ethnic differences in access to care and/or preferences based on family structure and cultural/economic factors. Particularly, heterogeneous patterns of service-specific expenditures by racial and ethnic groups underscore the importance of future research in identifying determinants leading to variations in service-specific expenditures among racial and ethnic groups.

2023 Alzheimer's disease facts and figures

“…White beneficiaries had the highest hospice payments, however, of all racial and ethnic groups. A study of racial and ethnic differences in health care spending using the Medical Expenditure Panel Survey found similar patterns in unadjusted total spending 786 . However, after adjusting for socioeconomic characteristics and functional status, total health care spending did not significantly differ among groups.…”

Impact of dementia: Health disparities, population trends, care interventions, and economic costs

“…There is a paucity of studies that examine heterogeneity of costs by demographic characteristics of PLWD such as race, ethnicity, and living arrangement 48 . Studies find both higher and lower medical expenditures among non‐whites compared with whites and variation across types of medical care expenditures likely reflecting differential access to care and preference for types of care 49 . Typically, PLWD have multiple comorbid conditions that contribute to healthcare use and costs 50 .…”

“…48 Studies find both higher and lower medical expenditures among nonwhites compared with whites and variation across types of medical care expenditures likely reflecting differential access to care and preference for types of care. 49 Typically, PLWD have multiple comorbid conditions that contribute to healthcare use and costs. 50 Persons with Alzheimer's dementia are more likely to be hospitalized and have longer stays and use more post-acute skilled nursing care and home health care than otherwise similar adults without dementia.…”

Racial and ethnic differences in disease course Medicare expenditures for beneficiaries with dementia

“…Dementia represents a substantial burden to society, with lifetime total care cost estimates as high as $377,621 per person with Alzheimer's dementia, including Medicare and Medicaid expenditures, out-of-pocket spending, and informal caregiving, more than twice the costs incurred by persons without dementia. 1,2 Research has revealed healthcare disparities, with much higher expenditures for Hispanic and non-Hispanic Black persons compared to non-Hispanic Whites with dementia. 3,4 Studies have found that Black Medicare beneficiaries with Alzheimer's disease and other dementias have the highest unadjusted Medicare expenditures, whereas White beneficiaries have the lowest.…”