Racial disparities and temporal trends in dementia misdiagnosis risk in the United States

Alzheimers Dement (N Y). 2019 Dec 9;5:891-898. doi: 10.1016/j.trci.2019.11.008. eCollection 2019.


Introduction: Systematic 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 to 2010.

Methods: We 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.

Results: Non-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.

Discussion: Our results suggest that efforts to reduce racial disparities in underdiagnosis are warranted.

Keywords: Alzheimer's disease; Clinical diagnosis; Dementia; Disparities; Health and retirement study.