Healthcare utilization of Mexican-American Medicare beneficiaries with and without Alzheimer’s disease and related dementias

English version

Autoři: Brian Downer ^aff001; Soham Al Snih ^aff001; Mukaila Raji ^aff002; Lin-Na Chou ^aff004; Yong-Fang Kuo ^aff002; Kyriakos S. Markides ^aff002; Kenneth J. Ottenbacher ^aff001
Působiště autorů: University of Texas Medical Branch, School of Health Professions, Division of Rehabilitation Sciences, Galveston, Texas, United States of America ^aff001; University of Texas Medical Branch, Sealy Center on Aging, Galveston, Texas, United States of America ^aff002; University of Texas Medical Branch, Internal Medicine–Geriatrics, Galveston, Texas, United States of America ^aff003; University of Texas Medical Branch, Office of Biostatistics, Galveston, Texas, United States of America ^aff004; University of Texas Medical Branch, Preventive Medicine and Population Health, Galveston, Texas, United States of America ^aff005
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0227681

Souhrn

Background

Older adults with Alzheimer’s disease and related dementias (ADRD) are high-risk to experience hospitalizations and emergency room (ER) admissions. Mexican-Americans have a high prevalence of ADRD, but there is limited information on the healthcare use of older Mexican-Americans with ADRD. We used data from a cohort of older Mexican-Americans that has been linked with Medicare files to investigate differences in hospitalizations, ER admissions, and physician visits according to ADRD diagnosis. We also identify sociodemographic, health, and functional characteristics that may contribute to differences in healthcare utilization between Mexican-American Medicare beneficiaries with and without an ADRD diagnosis.

Methods and findings

Data came from the Hispanic Established Populations for the Epidemiological Study of the Elderly that has been linked with Medicare Master Beneficiary Summary Files, Medicare Provider Analysis and Review files, Outpatient Standard Analytic files, and Carrier files. The final analytic sample included 1048 participants. Participants were followed for two years (eight quarters) after their survey interview. Generalized estimating equations were used to estimate the probability for one or more hospitalizations, ER admissions, and physician visits at each quarter. ADRD was associated with higher odds for hospitalizations (OR = 1.65, 95%CI = 1.29–2.11) and ER admissions (OR = 1.57, 95%CI = 1.23–1.94) but not physician visits (OR = 1.23, 95%CI = 0.91–1.67). The odds for hospitalizations (OR = 1.24, 95%CI = 0.97–1.60) and ER admissions (OR = 1.27, 95%CI = 1.01–1.59) were reduced after controlling for limitations in activities of daily living and comorbidities.

Conclusions

Mexican-American Medicare beneficiaries with ADRD had significantly higher odds for one or more hospitalizations and ER admissions but similar physician visits compared to beneficiaries without ADRD. Functional limitations and comorbidities contributed to the higher hospitalizations and ER admissions for older Mexican-Americans with ADRD.

Klíčová slova:

Activities of daily living – Alzheimer's disease – Cognitive impairment – Elderly – Hispanic people – Medicare – Outpatients – Physicians

Zdroje

1. Chen C, Zissimopoulos JM. Racial and ethnic differences in trends in dementia prevalence and risk factors in the United States. Alzheimers Dement (N Y). 2018;4:510–20. doi: 10.1016/j.trci.2018.08.009 30364652; PubMed Central PMCID: PMC6197734.

2. Matthews KA, Xu W, Gaglioti AH, Holt JB, Croft JB, Mack D, et al. Racial and ethnic estimates of Alzheimer's disease and related dementias in the United States (2015–2060) in adults aged >/ = 65 years. Alzheimers Dement. 2019;15(1):17–24. doi: 10.1016/j.jalz.2018.06.3063 30243772; PubMed Central PMCID: PMC6333531.

3. Mayeda ER, Haan MN, Kanaya AM, Yaffe K, Neuhaus J. Type 2 diabetes and 10-year risk of dementia and cognitive impairment among older Mexican Americans. Diabetes Care. 2013;36(9):2600–6. doi: 10.2337/dc12-2158 23514732; PubMed Central PMCID: PMC3747945.

4. Rodriguez FS, Aranda MP, Lloyd DA, Vega WA. Racial and ethnic disparities in dementia risk among individuals with low education. Am J Geriatr Psychiatry. 2018;26(9):966–76. doi: 10.1016/j.jagp.2018.05.011 30005921.

5. Feng C, Paasche-Orlow MK, Kressin NR, Rosen JE, Lopez L, Kim EJ, et al. Disparities in potentially preventable hospitalizations: Near-national estimates for Hispanics. Health Serv Res. 2018;53(3):1349–72. doi: 10.1111/1475-6773.12694 28378322; PubMed Central PMCID: PMC5980361.

6. Colligan EM, Pines JM, Colantuoni E, Wolff JL. Factors associated with frequent emergency department use in the Medicare population. Med Care Res Rev. 2017;74(3):311–27. doi: 10.1177/1077558716641826 27030234.

7. Pippins JR, Alegria M, Haas JS. Association between language proficiency and the quality of primary care among a national sample of insured Latinos. Medical care. 2007;45(11):1020–5. doi: 10.1097/MLR.0b013e31814847be 18049341; PubMed Central PMCID: PMC2836911.

8. Mayberry RM, Mili F, Ofili E. Racial and ethnic differences in access to medical care. Med Care Res Rev. 2000;57 Suppl 1:108–45. doi: 10.1177/1077558700057001S06 11092160.

9. Centers for Medicare & Medicaid Services. 2015 Medicare current beneficiary survey annual chartbook and slides. 2015 August 27, 2018. Report No.

10. Downer B, Al Snih S, Chou LN, Kuo YF, Markides KS, Ottenbacher KJ. Differences in hospitalizations, emergency room admissions, and outpatient visits among Mexican-American Medicare beneficiaries. BMC Geriatr. 2019;19(1):136. doi: 10.1186/s12877-019-1160-9 31113371.

11. Bynum JP, Rabins PV, Weller W, Niefeld M, Anderson GF, Wu AW. The relationship between a dementia diagnosis, chronic illness, medicare expenditures, and hospital use. J Am Geriatr Soc. 2004;52(2):187–94. doi: 10.1111/j.1532-5415.2004.52054.x 14728626.

12. Lin PJ, Fillit HM, Cohen JT, Neumann PJ. Potentially avoidable hospitalizations among Medicare beneficiaries with Alzheimer's disease and related disorders. Alzheimers Dement. 2013;9(1):30–8. doi: 10.1016/j.jalz.2012.11.002 23305822.

13. Mollers T, Stocker H, Wei W, Perna L, Brenner H. Length of hospital stay and dementia: A systematic review of observational studies. Int J Geriatr Psychiatry. 2019;34(1):8–21. doi: 10.1002/gps.4993 30260050.

14. Zhao Y, Kuo TC, Weir S, Kramer MS, Ash AS. Healthcare costs and utilization for Medicare beneficiaries with Alzheimer's. BMC Health Serv Res. 2008;8:108. doi: 10.1186/1472-6963-8-108 18498638; PubMed Central PMCID: PMC2424046.

15. Jutkowitz E, Kane RL, Dowd B, Gaugler JE, MacLehose RF, Kuntz KM. Effects of cognition, function, and behavioral and psychological symptoms on Medicare expenditures and health care uilization for persons with dementia. J Gerontol A Biol Sci Med Sci. 2017;72(6):818–24. doi: 10.1093/gerona/glx035 28369209; PubMed Central PMCID: PMC6075208.

16. Zhu CW, Cosentino S, Ornstein K, Gu Y, Andrews H, Stern Y. Use and cost of hospitalization in dementia: longitudinal results from a community-based study. Int J Geriatr Psychiatry. 2015;30(8):833–41. doi: 10.1002/gps.4222 25351909; PubMed Central PMCID: PMC4414886.

17. Gray HL, Jimenez DE, Cucciare MA, Tong HQ, Gallagher-Thompson D. Ethnic differences in beliefs regarding Alzheimer disease among dementia family caregivers. Am J Geriatr Psychiatry. 2009;17(11):925–33. doi: 10.1097/JGP.0b013e3181ad4f3c 20104051; PubMed Central PMCID: PMC4054932.

18. Connell CM, Scott Roberts J, McLaughlin SJ. Public opinion about Alzheimer disease among blacks, hispanics, and whites: results from a national survey. Alzheimer Dis Assoc Disord. 2007;21(3):232–40. doi: 10.1097/WAD.0b013e3181461740 17804956.

19. Cooper C, Tandy AR, Balamurali TB, Livingston G. A systematic review and meta-analysis of ethnic differences in use of dementia treatment, care, and research. Am J Geriatr Psychiatry. 2010;18(3):193–203. doi: 10.1097/JGP.0b013e3181bf9caf 20224516.

20. O'Bryant SE, Johnson L, Balldin V, Edwards M, Barber R, Williams B, et al. Characterization of Mexican Americans with mild cognitive impairment and Alzheimer's disease. J Alzheimers Dis. 2013;33(2):373–9. doi: 10.3233/JAD-2012-121420 22976076; PubMed Central PMCID: PMC3524411.

21. Fitten LJ, Ortiz F, Fairbanks L, Bartzokis G, Lu P, Klein E, et al. Younger age of dementia diagnosis in a Hispanic population in southern California. Int J Geriatr Psychiatry. 2014;29(6):586–93. doi: 10.1002/gps.4040 24478258; PubMed Central PMCID: PMC4013239.

22. Hernandez S, McClendon MJ, Zhou XH, Sachs M, Lerner AJ. Pharmacological treatment of Alzheimer's disease: effect of race and demographic variables. J Alzheimers Dis. 2010;19(2):665–72. doi: 10.3233/JAD-2010-1269 20110610; PubMed Central PMCID: PMC2827609.

23. Thorpe CT, Fowler NR, Harrigan K, Zhao X, Kang Y, Hanlon JT, et al. Racial and ethnic differences in initiation and discontinuation of antidementia drugs by Medicare beneficiaries. J Am Geriatr Soc. 2016;64(9):1806–14. doi: 10.1111/jgs.14403 27549029; PubMed Central PMCID: PMC5026892.

24. Nguyen C, Downer B, Chou LN, Kuo YF, Raji M. End-of-Life Healthcare Utilization of Older Mexican-Americans with and without a Diagnosis of Alzheimer's Disease and Related Dementias. J Gerontol A Biol Sci Med Sci. 2019. Epub 2019/03/12. doi: 10.1093/gerona/glz065 30855070.

25. Markides KS, Stroup-Benham CA, Goodwin JS, Perkowski LC, Lichtenstein M, Ray LA. The effect of medical conditions on the functional limitations of Mexican-American elderly. Annals of epidemiology. 1996;6(5):386–91. doi: 10.1016/s1047-2797(96)00061-0 8915469.

26. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98. Epub 1975/11/01. doi: 10.1016/0022-3956(75)90026-6 1202204.

27. Downer B, Al Snih S, Howrey BT, Raji MA, Markides KS, Ottenbacher KJ. Combined effects of cognitive impairment and pre-frailty on future frailty and death in older Mexican Americans. Aging Ment Health. 2018:1–8. doi: 10.1080/13607863.2018.1493719 30472880.

28. Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Medical care. 2005;43(11):1130–9. doi: 10.1097/01.mlr.0000182534.19832.83 16224307.

29. Muller CJ, MacLehose RF. Estimating predicted probabilities from logistic regression: different methods correspond to different target populations. Int J Epidemiol. 2014;43(3):962–70. doi: 10.1093/ije/dyu029 24603316; PubMed Central PMCID: PMC4052139.

30. Nair R, Haynes VS, Siadaty M, Patel NC, Fleisher AS, Van Amerongen D, et al. Retrospective assessment of patient characteristics and healthcare costs prior to a diagnosis of Alzheimer's disease in an administrative claims database. BMC Geriatr. 2018;18(1):243. doi: 10.1186/s12877-018-0920-2 30326851; PubMed Central PMCID: PMC6192320.

31. Chen L, Reed C, Happich M, Nyhuis A, Lenox-Smith A. Health care resource utilisation in primary care prior to and after a diagnosis of Alzheimer's disease: a retrospective, matched case-control study in the United Kingdom. BMC Geriatr. 2014;14:76. Epub 2014/06/18. doi: 10.1186/1471-2318-14-76 24934556; PubMed Central PMCID: PMC4073513.

32. Lin PJ, Zhong Y, Fillit HM, Chen E, Neumann PJ. Medicare Expenditures of Individuals with Alzheimer's Disease and Related Dementias or Mild Cognitive Impairment Before and After Diagnosis. J Am Geriatr Soc. 2016;64(8):1549–57. doi: 10.1111/jgs.14227 27295430.

33. Geldmacher DS, Kirson NY, Birnbaum HG, Eapen S, Kantor E, Cummings AK, et al. Pre-diagnosis excess acute care costs in Alzheimer's patients among a US Medicaid population. Appl Health Econ Health Policy. 2013;11(4):407–13. Epub 2013/05/24. doi: 10.1007/s40258-013-0038-9 23700254.

34. Suehs BT, Davis CD, Alvir J, van Amerongen D, Pharmd NC, Joshi AV, et al. The clinical and economic burden of newly diagnosed Alzheimer's disease in a medicare advantage population. Am J Alzheimers Dis Other Demen. 2013;28(4):384–92. Epub 2013/05/21. doi: 10.1177/1533317513488911 23687180.

35. Eaker ED, Mickel SF, Chyou PH, Mueller-Rizner NJ, Slusser JP. Alzheimer's disease or other dementia and medical care utilization. Annals of epidemiology. 2002;12(1):39–45. Epub 2001/12/26. doi: 10.1016/s1047-2797(01)00244-7 11750239.

36. Albrecht JS, Hanna M, Kim D, Perfetto EM. Increased Health Care Utilization in Dementia Subtypes Before Diagnosis. Alzheimer Dis Assoc Disord. 2018;32(4):326–32. Epub 2018/10/10. doi: 10.1097/WAD.0000000000000277 30299276.

37. Desai U, Kirson NY, Ye W, Mehta NR, Wen J, Andrews JS. Trends in health service use and potentially avoidable hospitalizations before Alzheimer's disease diagnosis: A matched, retrospective study of US Medicare beneficiaries. Alzheimers Dement (Amst). 2019;11:125–35. Epub 2019/02/23. doi: 10.1016/j.dadm.2018.12.005 30788409; PubMed Central PMCID: PMC6369145.

38. Zhu CW, Scarmeas N, Torgan R, Albert M, Brandt J, Blacker D, et al. Longitudinal study of effects of patient characteristics on direct costs in Alzheimer disease. Neurology. 2006;67(6):998–1005. doi: 10.1212/01.wnl.0000230160.13272.1b 16914696.

39. Covinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic D, et al. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc. 2003;51(4):451–8. doi: 10.1046/j.1532-5415.2003.51152.x 12657063.

40. Boyd CM, Ricks M, Fried LP, Guralnik JM, Xue QL, Xia J, et al. Functional decline and recovery of activities of daily living in hospitalized, disabled older women: the Women's Health and Aging Study I. J Am Geriatr Soc. 2009;57(10):1757–66. doi: 10.1111/j.1532-5415.2009.02455.x 19694869; PubMed Central PMCID: PMC2805561.

41. Boyd CM, Landefeld CS, Counsell SR, Palmer RM, Fortinsky RH, Kresevic D, et al. Recovery of activities of daily living in older adults after hospitalization for acute medical illness. J Am Geriatr Soc. 2008;56(12):2171–9. doi: 10.1111/j.1532-5415.2008.02023.x 19093915; PubMed Central PMCID: PMC2717728.

42. Pitta F, Troosters T, Probst VS, Spruit MA, Decramer M, Gosselink R. Physical activity and hospitalization for exacerbation of COPD. Chest. 2006;129(3):536–44. doi: 10.1378/chest.129.3.536 16537849.

43. Tian W. An all-payer view of hospital discharge to postacute care, 2013. HCUP Statistical Brief #2052016. Available from: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb205-Hospital-Discharge-Postacute-Care.pdf.

44. Mizrahi EH, Arad M, Adunsky A. Pre-stroke dementia does not affect the post-acute care functional outcome of old patients with ischemic stroke. Geriatr Gerontol Int. 2016;16(8):928–33. doi: 10.1111/ggi.12574 26338013.

45. Loomer L, Downer B, Thomas KS. Relationship between Functional Improvement and Cognition in Short-Stay Nursing Home Residents. J Am Geriatr Soc. 2019;67(3):553–7. Epub 2018/12/15. doi: 10.1111/jgs.15708 30548843; PubMed Central PMCID: PMC6402985.

46. Givens JL, Mitchell SL, Kuo S, Gozalo P, Mor V, Teno J. Skilled nursing facility admissions of nursing home residents with advanced dementia. J Am Geriatr Soc. 2013;61(10):1645–50. doi: 10.1111/jgs.12476 24117283; PubMed Central PMCID: PMC3801431.

47. Bauer K, Schwarzkopf L, Graessel E, Holle R. A claims data-based comparison of comorbidity in individuals with and without dementia. BMC Geriatr. 2014;14:10. doi: 10.1186/1471-2318-14-10 24472217; PubMed Central PMCID: PMC3909381.

48. Bunn F, Burn AM, Goodman C, Rait G, Norton S, Robinson L, et al. Comorbidity and dementia: a scoping review of the literature. BMC Med. 2014;12:192. doi: 10.1186/s12916-014-0192-4 25358236; PubMed Central PMCID: PMC4229610.

49. Zhu CW, Cosentino S, Ornstein K, Gu Y, Scarmeas N, Andrews H, et al. Medicare Utilization and Expenditures Around Incident Dementia in a Multiethnic Cohort. J Gerontol A Biol Sci Med Sci. 2015;70(11):1448–53. doi: 10.1093/gerona/glv124 26311543; PubMed Central PMCID: PMC4612389.

50. Nicholas LH, Bynum JP, Iwashyna TJ, Weir DR, Langa KM. Advance directives and nursing home stays associated with less aggressive end-of-life care for patients with severe dementia. Health Aff (Millwood). 2014;33(4):667–74. doi: 10.1377/hlthaff.2013.1258 24711329; PubMed Central PMCID: PMC4159465.

51. Read JG, Smith PB. Gender and national origin differences in healthcare utilization among U.S. Immigrants from Mexico, China, and India. Ethn Health. 2018;23(8):867–83. doi: 10.1080/13557858.2017.1297776 28277018.

52. Insaf TZ, Jurkowski JM, Alomar L. Sociocultural factors influencing delay in seeking routine health care among Latinas: a community-based participatory research study. Ethn Dis. 2010;20(2):148–54. 20503895.

53. Saha S, Komaromy M, Koepsell TD, Bindman AB. Patient-physician racial concordance and the perceived quality and use of health care. Arch Intern Med. 1999;159(9):997–1004. doi: 10.1001/archinte.159.9.997 10326942.

54. Meghani SH, Brooks JM, Gipson-Jones T, Waite R, Whitfield-Harris L, Deatrick JA. Patient-provider race-concordance: does it matter in improving minority patients' health outcomes? Ethn Health. 2009;14(1):107–30. doi: 10.1080/13557850802227031 19012091; PubMed Central PMCID: PMC3209820.

55. Natalwala A, Potluri R, Uppal H, Heun R. Reasons for hospital admissions in dementia patients in Birmingham, UK, during 2002–2007. Dement Geriatr Cogn Disord. 2008;26(6):499–505. doi: 10.1159/000171044 19005254.

56. Toot S, Devine M, Akporobaro A, Orrell M. Causes of hospital admission for people with dementia: a systematic review and meta-analysis. J Am Med Dir Assoc. 2013;14(7):463–70. doi: 10.1016/j.jamda.2013.01.011 23510826.

57. Wilkinson T, Ly A, Schnier C, Rannikmae K, Bush K, Brayne C, et al. Identifying dementia cases with routinely collected health data: A systematic review. Alzheimers Dement. 2018;14(8):1038–51. doi: 10.1016/j.jalz.2018.02.016 29621480; PubMed Central PMCID: PMC6105076.

58. Zhu CW, Ornstein KA, Cosentino S, Gu Y, Andrews H, Stern Y. Misidentification of dementia in Medicare claims and related costs. J Am Geriatr Soc. 2019;67(2):269–76. doi: 10.1111/jgs.15638 30315744.

59. Ramirez M, Teresi JA, Holmes D, Gurland B, Lantigua R. Differential item functioning (DIF) and the Mini-Mental State Examination (MMSE). Overview, sample, and issues of translation. Medical care. 2006;44(11 Suppl 3):S95–S106. doi: 10.1097/01.mlr.0000245181.96133.db 17060840.

60. Gonzalez-Barrera A, Lopez MH. A demographic portrait of Mexican-Origin Hispanics in the United States. Washington DC: Pew Research Hispanic Center2013.

61. Gonzalez-Barrera A, Lopez MH. Ranking Latino populations in the States. Washington DC: Pew Research Hispanic Center2013.

62. Díaz-Venegas C, Downer B, Langa KM, Wong R. Cognitive functioning of U.S. adults by race and Hispanic origin. In: Vega William A., Angel Jacqueline L., Luis Miguel F. Gutiérrez Robledo, Markides KS, editors. Contextualizing Health and Aging in the Americas: Effects of Space, Time and Place. Switzerland: Springer Nature; 2019. p. 85–.

Healthcare utilization of Mexican-American Medicare beneficiaries with and without Alzheimer’s disease and related dementias

Souhrn

Background

Methods and findings

Conclusions

Klíčová slova:

Zdroje

PLOS One

Svět praktické medicíny 1/2024 (znalostní test z časopisu)

Koncepce osteologické péče pro gynekology a praktické lékaře

Sekvenční léčba schizofrenie

Hypertenze a hypercholesterolémie – synergický efekt léčby

Význam metforminu pro „udržitelnou“ terapii diabetu