Disparities in the Setting of Initial Dementia Diagnosis: Influence of Race, Ethnicity, and Primary Care Use.
Aaron Bloschichak, Ming-Ting Yang, Rajesh Makineni and 4 others
PMID 41734883WHAT IT FOUND
In newly diagnosed dementia, Black Medicare beneficiaries were more likely than White beneficiaries to first receive diagnosis in hospital or nursing home.
Recent primary care visits were associated with more community diagnoses and a smaller Black and White gap.
Key findings
01In adjusted models, Black beneficiaries had 37% higher relative odds than White beneficiaries of receiving their first dementia diagnosis in a skilled nursing facility or nursing home.
02Recent primary care use was associated with lower relative odds of diagnosis in acute or nursing home settings, and this association was stronger for Black and Hispanic beneficiaries.
03Without recent primary care, Black beneficiaries were 2.0 percentage points more likely than White beneficiaries to be diagnosed in an acute setting; with recent primary care, the difference was -0.3 percentage points and not statistically significant.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used the setting of first diagnosis as a proxy for timeliness, not direct measures of symptom onset or disease stage. Claims data captured only diagnosed dementia in 2022 and did not capture undiagnosed dementia, non-billable cognitive assessments, or milder cognitive impairment. The sample excluded Medicare Advantage enrollees, so the findings may not apply to people with Medicare Advantage plans. Primary care use was measured only in the six months before diagnosis, which may not reflect longer-term engagement or wait times for specialist evaluation. The study adjusted for many characteristics but could not account for cognitive severity, functional status, caregiver support, or patient-clinician communication factors. The 2022 study year may reflect lingering pandemic-related disruptions to care. The distribution of diagnosis settings may differ from earlier studies because of coding and case-definition rules.
Declared interests
The authors declared no conflict of interest. The article is listed as supported by NIH extramural and non-U.S. government research support.
The easy way to misread this
Do not conclude that primary care visits cause earlier diagnosis or remove racial disparities. The study was observational, did not randomize primary care use, and used diagnosis setting as a proxy for timeliness. It also grouped nurse practitioner visits with other primary care visits, so it cannot show the effect of nursing care alone.