title: Ethnic Variations in Prognosis of Patients with Dementia: A Prospective Nationwide Registry Linkage Study in The Netherlands.
abstract: Data on dementia prognosis among ethnic minority groups are limited in Europe.
  
  
  
  We assessed differences in short-term (1-year) and long-term (3-year) mortality and readmission risk after a first hospitalization or first ever referral to a day clinic for dementia between ethnic minority groups and the ethnic Dutch population in the NetherlandsMethods: Nationwide prospective cohorts of first hospitalized dementia patients (N = 55,827) from January 1, 2000 to December 31, 2010 were constructed. Differences in short-term and long-term mortality and readmission risk following hospitalization or referral to the day clinic between ethnic minority groups (Surinamese, Turkish, Antilleans, Indonesians) and the ethnic Dutch population were investigated using Cox proportional hazard regression models with adjustment for age, sex, and comorbidities.
  
  
  
  Age-sex-adjusted short-term and long-term risks of death following a first hospitalization with dementia were comparable between the ethnic minority groups and the ethnic Dutch. Age- and sex-adjusted risk of admission was higher only in Turkish compared with ethnic Dutch (HR 1.57, 95% CI,1.08-2.29). The difference between Turkish and the Dutch attenuated and was no longer statistically significant after further adjustment for comorbidities. There were no ethnic differences in short-term and long-term risk of death, and risk of readmission among day clinic patients.
  
  
  
  Compared with Dutch patients with a comparable comorbidity rate, ethnic minority patients with dementia did not have a worse prognosis. Given the poor prognosis of dementia, timely and targeted advance care planning is essential, particularly in ethnic minority groups who are mired by cultural barriers and where uptake of advance care planning is known to be low.
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Charles
authors.initials: C
authors.lastname: Agyemang
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.|Department of Geriatrics, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Irene E
authors.initials: IE
authors.lastname: van de Vorst
authors.affiliation: Department of Geriatrics, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Huiberdina L
authors.initials: HL
authors.lastname: Koek
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.affiliation: Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY, USA.
authors.forename: Azizi
authors.initials: A
authors.lastname: Seixas
authors.affiliation: Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark.|Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Marie
authors.initials: M
authors.lastname: Norredam
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Umar
authors.initials: U
authors.lastname: Ikram
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Ilonca
authors.initials: I
authors.lastname: Vaartjes
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology* / Q000208:ethnology* / Q000401:mortality; D005006:Ethnicity; D005060:Europe; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007214:Indonesia; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D013997:Time Factors; D014421:Turkey
keywords: Dementia; Netherlands; ethnic minority groups; ethnicity