Study Suggests Ethnic Disparities in the Treatment of Veterans with Dementia
Dementia is associated with great morbidity and mortality. Moreover, among Veterans aged 55-64 years, dementia resulted in the second highest cause of death after cancer, and previous studies suggest a higher prevalence of dementia among African Americans. This study sought to determine if there were ethnic disparities in the evaluation and treatment of dementia among 410 Veterans treated at one VAMC between 4/05 and 6/05. Investigators reviewed patient charts for demographics (i.e., age, ethnicity) and diagnostic testing for dementia (i.e., labs, imaging workup, neuropsychological testing). They also assessed pharmacological treatment for dementia, such as acetylcholinesterase inhibitors (CHEIs) that are considered the "mainstay of treatment" for dementia.
Findings show that while laboratory and imaging workup (i.e., CT, MRI) did not differ between ethnic groups, there were significant differences in the treatment of dementia. For example, African American Veterans with dementia were 40% less likely than all other patients to receive CHEIs. This treatment disparity did not appear to be due to differences in the evaluation of dementia, which was similar across groups, although significantly more Caucasian Veterans (43.8%) underwent neuropsychological testing compared to African American (24.8%) or Hispanic Veterans (32.4%). Investigators did not have data regarding the number of patients to whom CHEIs were recommended versus the number of patients taking them. The authors recommend further research to determine the cause(s) of disparities in the treatment of dementia.
Kalkonde Y, Pinto-Patarroyo G, Goldman T, Strutt A, York M, Kunik M, and Schulz P. Ethnic disparities in the treatment of dementia in Veterans. Dementia and Geriatric Cognitive Disorders September 2009;28(2):145-152.
This study was supported through the Michael E. DeBakey VA Medical Center in Houston, TX. All authors are part of this VAMC. Dr. Kunik also is part of HSR&D's Houston Center for Quality of Care and Utilization Studies.