Racial disparities and temporal trends in dementia misdiagnosis risk in the United States
Racial disparities and temporal trends in dementia misdiagnosis risk in the United States
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DOI：
10.1016/j.trci.2019.11.008
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发表时间：
2019-01-01
影响因子：
4.8
通讯作者：
Power, Melinda C.
中科院分区：
文献类型：
--
作者：
Gianattasio, Kan Z.;Prather, Christina;Power, Melinda C.
简介不同种族/族裔群体痴呆症误诊的系统性差异会对健康差异产生影响。我们比较了 2000 年至 2010 年不同种族/族裔群体的临床环境中痴呆症诊断不足和过度诊断的风险。方法我们将按服务收费的医疗保险索赔与来自全国代表性健康和退休研究的年龄 >= 70 岁的参与者联系起来。我们使用跨种族/族裔群体具有相似敏感性和特异性的算法对痴呆症状态进行分类，并使用医疗保险索赔中的 ICD-9-CM 代码分配临床痴呆症诊断状态。使用多项 Logit 模型来估计组间和随时间推移的临床诊断不足和过度诊断的相对风险。结果非西班牙裔黑人的诊断不足风险大约是非西班牙裔白人的两倍。虽然初步分析表明差异随着时间的推移而缩小，但这对于敏感性分析或协变量调整来说并不稳健。随着时间的推移，两组的过度诊断风险都会增加。讨论我们的结果表明，有必要努力减少诊断不足的种族差异。
IntroductionSystematic disparities in misdiagnosis of dementia across racial/ethnic groups have implications for health disparities. We compared the risk of dementia under- and overdiagnosis in clinical settings across racial/ethnic groups from 2000 to2010.MethodsWe linked fee-for-service Medicare claims to participants aged >= 70 from the nationally representative Health and Retirement Study. We classified dementia status using an algorithm with similar sensitivity and specificity across racial/ethnic groups and assigned clinical dementia diagnosis status using ICD-9-CM codes from Medicare claims. Multinomial logit models were used to estimate relative risks of clinical under- and overdiagnosis between groups and over time.ResultsNon-Hispanic blacks had roughly double the risk of underdiagnosis as non-Hispanic whites. While primary analyses suggested a shrinking disparity over time, this was not robust to sensitivity analyses or adjustment for covariates. Risk of overdiagnosis increased over time in both groups.DiscussionOur results suggest that efforts to reduce racial disparities in underdiagnosis are warranted.