A systematic review and meta-analysis of ethnic differences in use of dementia treatment, care, and research.
The number of people with dementia from minority ethnic (ME) groups in western countries is projected to rise dramatically, and they may be less able to access dementia services. To compare the use of health and social services, treatments for dementia and dementia research between different ethnic groups. A systematic review of 33 articles fitting predetermined criteria. Compatible results were pooled in a meta-analysis. ME people with dementia were more cognitively impaired, and Hispanic people reported a longer duration of memory loss than non-ME people, at the time of referral to diagnostic dementia services in the United States and Australia {pooled weighted mean difference on Mini-Mental State Examination = 3.48 (95% confidence interval [CI]: 2.87-4.09); z = 11.19, p <0.0001; N = 2,090}. These differences remained after controlling for premorbid level of education. The use of community social services did not vary between ME and non-ME people with dementia, but African Americans were 30% less likely to be prescribed cholinesterase inhibitors {odds ratio (OR) 0.7 [0.6-0.9]; z = -3.1, p = 0.002; N = 175}, and ME groups were underrepresented in U.S. dementia drug trials. ME people with dementia were 40% less likely to enter 24-hour care (pooled hazard ratio 0.59 [95% CI: 0.52-0.69]; z = -7.15, p <0.0001; N = 12,053). The authors found consistent evidence, mostly from the United States, that ME people accessed diagnostic services later in their illness, and once they received a diagnosis, were less likely to access antidementia medication, research trials, and 24-hour care. Increasing community engagement and specific recruitment strategies for ME groups might help address inequalities, and these need to be evaluated. More research is also needed to evaluate ME access to dementia services outside the United States.
Cooper
Claudia
C
Department of Mental Health Sciences, University College London, Archway Campus, Highgate Hill, London, United Kingdom. ccooper@doctors.org.uk
Tandy
Alec Robert
AR
Balamurali
Thana B S
TB
Livingston
Gill
G
D001315:Australia; D003704:Dementia / Q000188:drug therapy* / Q000208:ethnology* / Q000628:therapy; D005006:Ethnicity / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data; D008605:Mental Health Services / Q000706:statistics & numerical data; D008913:Minority Groups / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D006113:United Kingdom; D014481:United States