Diagnosis of Behavioral Symptoms of Dementia and CNS-Active Drug Use Among Diverse Persons Living With Dementia

Abstract Approximately 90% of persons living with dementia (PLWD) experience behavioral and psychological symptoms of dementia (BPSD). Studies demonstrated high use of central nervous system (CNS) active drugs in nursing homes; one recent study documented high use among community-dwelling PLWD. Racial/ethnic disparities in BPSD diagnosis and CNS-active drug use, however, are unknown. We quantified disparities in BPSD diagnoses and CNS-active drug use using 100% Medicare Part A and B claims, 2017-2019, and Part D, 2018-2019. Beneficiaries were ages 65 and older in 2017, community-dwelling, and had a dementia diagnosis (n=801,597). We estimated models of CNS-active drug use to quantify racial/ethnic differences adjusting for confounders. Among PLWD, 66% had a BPSD diagnosis and 65% were taking a CNS-acting drug. Asians/Pacific Islanders were less likely to have a BPSD diagnosis (55%) than other groups, particularly affective diagnoses (40%). Whites were most likely to have any diagnosis (67%). Blacks were most likely to have hyperactivity diagnoses (7%). Antidepressants were most commonly used drug class (44%). Thirteen percent used an antipsychotic. Models adjusted for age, sex, comorbid conditions, dual-eligibility and BPSD diagnoses, showed non-Whites were less likely to use any CNS-active drug than Whites, but Blacks and Hispanics were slightly more likely to use antipsychotics. We found racial/ethnic differences in BPSD diagnoses and CNS-active drug use. Whether these disparities are due to differences in BPSD symptoms, health-care access or care-seeking remains an important question. Further study of disparity in outcomes associated with use will inform risk and benefit of CNS-active drugs use among PLWD.

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Geographic Regional Variation in Patterns of Racial and Ethnic Disparities in Late-Life Depression

Innovation in Aging ◽

10.1093/geroni/igaa057.545 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 168-168

Author(s):

Chirag Vyas ◽

Charles Reynolds ◽

David Mischoulon ◽

Grace Chang ◽

Olivia Okereke

Keyword(s):

Native American ◽

Ethnic Differences ◽

Ethnic Disparities ◽

Late Life ◽

Geographic Region ◽

Omega 3 ◽

Late Life Depression ◽

Item Level ◽

Racial Ethnic ◽

Hispanic White

Abstract There is evidence of racial/ethnic disparities in late-life depression (LLD) burden and treatment in the US. Geographic region may be a novel social determinant; yet, limited data exist regarding the interplay of geographic region with racial/ethnic differences in LLD severity, item-level symptom burden and treatment. We conducted a cross-sectional study among 25,503 men aged 50+ years and women aged 55+ years in VITAL-DEP (VITamin D and OmegA-3 TriaL-Depression Endpoint Prevention), an ancillary study to the VITAL trial. Racial/ethnic groups included Non-Hispanic White, Black, Hispanic, Asian, and other groups (Native American/Alaskan Native and other/multiple/unspecified-race/ethnicity). We assessed depression status using: the Patient Health Questionnaire-8 (PHQ-8); self-reported clinician/physician diagnosis of depression; medication and/or counseling treatment for depression. In the full sample, Midwest region was significantly associated with 12% lower severity of LLD, compared to Northeast region (rate ratio (RR) (95% confidence interval (CI)): 0.88 (0.83-0.93)). However, racial/ethnic differences in LLD varied by region. For example, in the Midwest, Blacks and Hispanics had significantly higher depression severity compared to non-Hispanic Whites (RR (95% CI): for Black, 1.16 (1.02-1.31); for Hispanic, 2.03 (1.38-3.00)). Furthermore, in multivariable-adjusted logistic regression models, minority vs. non-Hispanic White adults had 2- to 3-fold significantly higher odds of several item-level symptoms across all regions, especially in the Midwest and Southwest. Finally, among those endorsing PHQ-8≥10, Blacks had 60-80% significantly lower odds of depression treatment, compared to non-Hispanic Whites, in all regions. In summary, we observed significant geographic variation in patterns of racial/ethnic disparities in LLD outcomes. This requires further longitudinal investigation.

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Relationship of Alcohol Use to Delinquency and Illicit Drug Use in Adolescents: Gender, Age, and Racial/Ethnic Differences

Journal of Drug Issues ◽

10.1177/002204260203200107 ◽

2002 ◽

Vol 32 (1) ◽

pp. 153-178 ◽

Cited By ~ 101

Author(s):

Grace M. Barnes ◽

John W. Welte ◽

Joseph H. Hoffman

Keyword(s):

Alcohol Use ◽

Drug Use ◽

Ethnic Differences ◽

Illicit Drug ◽

Illicit Drug Use ◽

Relationship Of ◽

Racial Ethnic

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Abstract B48: Health care access and breast cancer aggressiveness contribute separately to racial/ethnic disparities in stage at diagnosis

10.1158/1055-9965.disp-11-b48 ◽

2011 ◽

Cited By ~ 1

Author(s):

Garth H. Rauscher ◽

Richard T. Campbell ◽

Kathryn Weaver ◽

Richard B. Warnecke

Keyword(s):

Breast Cancer ◽

Health Care ◽

Health Care Access ◽

Ethnic Disparities ◽

Stage At Diagnosis ◽

Care Access ◽

Cancer Aggressiveness ◽

Racial Ethnic

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Temporal Trends in Racial and Ethnic Disparities in Sleep Duration in the United States: A National Health Interview Survey Analysis from 2004 to 2018

10.1101/2021.10.31.21265202 ◽

2021 ◽

Author(s):

César Caraballo ◽

Shiwani Mahajan ◽

Javier Valero-Elizondo ◽

Daisy Massey ◽

Yuan Lu ◽

...

Keyword(s):

Sleep Duration ◽

Ethnic Differences ◽

Household Income ◽

National Health Interview Survey ◽

Temporal Trends ◽

Ethnic Disparities ◽

Short Sleep ◽

Long Sleep ◽

Interview Survey ◽

Racial Ethnic

Importance: Minoritized racial and ethnic groups are generally more likely to experience sleep deficiencies. It is unclear how these sleep duration disparities have changed over recent years. Objective: To determine 15–year trends in the racial and ethnic differences in self–reported sleep duration among adults in the US. Design: Serial cross–sectional study. Setting: National Health Interview Survey from years 2004–2018. Participants: 429,195 non–institutionalized adults. Exposures: Self–reported race, ethnicity, household income, and sex/gender. Main Outcomes: Temporal trends and racial/ethnic differences in short– and long–sleep duration (≤6 and ≥10 hours in a 24–hour period, respectively) and racial/ethnic differences in the relationship between sleep duration and age. Results: The study sample consisted of 429,195 individuals (mean age 46.5 [SE, 0.08] years; 51.7% female) of which 5.1% identified as Asian, 11.8% as Black, 14.7% as Latino/Hispanic, and 68.5% as White. In 2004, the adjusted estimated prevalence of short–sleep duration and long–sleep duration, respectively, were 31.3% and 2.5% among Asian individuals, 35.3% and 6.4% among Black individuals, 27.0% and 4.6% among Latino/Hispanic individuals, and 27.8% and 3.5% among White individuals. Over the study period, there was a significant increase in the short sleep prevalence among Black, Latino/Hispanic, and White individuals (P≤0.02 for each), whereas prevalence of long sleep changed significantly only among Latino/Hispanic individuals (–1.4 points, P=0.01). In 2018, compared with White individuals, short sleep prevalence among Black and Latino/Hispanic individuals was higher by 10.7 points and 2.6 points, respectively (P≤0.02 each), and long sleep prevalence among Black people was significantly higher by 1.4 points (P=0.01). These racial/ethnic disparities were the greatest among women and among those with middle/high household income. Over the study period, Black individuals younger than 60 years old had the highest prevalence of short sleep compared with those of the same age; and Black individuals had a higher long–sleep duration prevalence than White individuals across all age groups. Conclusions: From 2004 to 2018, the prevalence of unrecommended sleep duration was persistently higher among Black individuals. The Black–White disparities were highest among women, individuals who had middle or high income, and among young or middle–aged adults.

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Racial/ethnic disparities in health care access and use are not explained by health insurance and income

PsycEXTRA Dataset ◽

10.1037/e556782006-002 ◽

2000 ◽

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Care Access ◽

Ethnic Disparities ◽

Care Access ◽

Racial Ethnic

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RACE/ETHNICITY AND U.S. ADULT MORTALITY

Du Bois Review Social Science Research on Race ◽

10.1017/s1742058x11000051 ◽

2011 ◽

Vol 8 (1) ◽

pp. 5-24 ◽

Cited By ~ 46

Author(s):

Robert A. Hummer ◽

Juanita J. Chinn

Keyword(s):

Ethnic Differences ◽

Mexican Americans ◽

Mexican Immigrants ◽

Ethnic Disparities ◽

Adult Mortality ◽

Social Resources ◽

Socioeconomic Resources ◽

Race Ethnicity ◽

Racial Ethnic ◽

Lower Mortality Risk

AbstractAlthough there have been significant decreases in U.S. mortality rates, racial/ethnic disparities persist. The goals of this study are to: (1) elucidate a conceptual framework for the study of racial/ethnic differences in U.S. adult mortality, (2) estimate current racial/ethnic differences in adult mortality, (3) examine empirically the extent to which measures of socioeconomic status and other risk factors impact the mortality differences across groups, and (4) utilize findings to inform the policy community with regard to eliminating racial/ethnic disparities in mortality. Relative Black-White differences are modestly narrower when compared to a decade or so ago, but remain very wide. The majority of the Black-White adult mortality gap can be accounted for by measures of socioeconomic resources that reflect the historical and continuing significance of racial socioeconomic stratification. Further, when controlling for socioeconomic resources, Mexican Americans and Mexican immigrants exhibit significantly lower mortality risk than non-Hispanic Whites. Without aggressive efforts to create equality in socioeconomic and social resources, Black-White disparities in mortality will remain wide, and mortality among the Mexican-origin population will remain higher than what would be the case if that population achieved socioeconomic equality with Whites.

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