Racial differences in the diagnosis of dementia and in its effects on the use and costs of health care services
Racial differences in the diagnosis of dementia and in its effects on the use and costs of health care services
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DOI：
10.1176/appi.ps.54.1.92
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发表时间：
2003-01-01
影响因子：
3.8
通讯作者：
Cain, VA
中科院分区：
文献类型：
--
作者：
Husaini, BA;Sherkat, DE;Cain, VA
目的：这项研究检查了不同种族和性别的医疗保险受益人中痴呆症患病率的差异，以及痴呆症对医疗保健服务使用和费用的影响的种族差异。研究方法：对田纳西州1991年至1993年期间提交索赔的医疗保险受益人（N = 33，680）的5%随机样本进行了分析。痴呆症的评估是基于卫生保健融资管理局（HCFA）账单记录中的ICD-9代码，沿着性别、种族、共病精神疾病、卫生服务使用情况和HCFA支付的实际金额等信息。与阿尔茨海默病相关的痴呆患者被排除在外。结果如下：痴呆症的诊断在非洲裔美国人受益人中比在白色受益人中更普遍（5%比3.9%）。痴呆症患者的卫生服务使用率较高，特别是住院护理，非裔美国人痴呆症患者的服务使用水平最高。对于被诊断患有痴呆症的非裔美国人来说，医疗保健费用也显着更高。在任何种族的患者中，患有精神疾病的患者的费用都大大高于她。结论：痴呆症患病率的种族差异是显而易见的。种族也在痴呆症对医疗服务的使用和成本的影响中发挥作用，非洲裔美国人昂贵的住院治疗率较高。痴呆症的患病率和费用的种族差异对医疗保健系统造成了相当大的负担。解决痴呆症患病率的种族差异将节省大量费用。
Objective: This study, examined differences in the prevalence of dementia among Medicare beneficiaries by race and gender as well as racial differences in the effects of dementia on the use and costs of health care services. Methods: Data from a 5 percent random sample of Medicare beneficiaries in the state of Tennessee who filed claims between 1991 and 1993 (N = 33,680) were analyzed. Dementia was assessed on the basis of ICD-9 codes in the billing records of the Health Care Financing Administration (HCFA), along with information on gender, race, comorbid psychiatric conditions, use of health services, and the actual amounts paid by HCFA. Patients with dementia related to Alzheimer's disease were excluded. Results: Diagnoses of dementia were significantly, more prevalent among African-American beneficiaries than among white beneficiaries (5 percent compared with 3.9 percent). Persons with dementia had higher rates of health service use, particularly for inpatient care, and African-American persons with dementia had the highest levels of service use. Health care costs were also significantly higher for African Americans with a diagnosis of dementia. Among patients of either race, costs were substantially hi her among those with comorbid psychiatric conditions. Conclusions: Racial differences in the prevalence of dementia are clearly evident. Race also plays a role in the effects of dementia on the use and costs of health services, with higher rates of expensive inpatient care among African Americans. Racial differences in both the prevalence and costs of dementia produce a considerable burden on the health care system. Addressing racial disparities in the prevalence of dementia would result in substantial cost savings.