Disparities in Memory Clinic Visits and Dementia Severity Identified in Disadvantaged Neighborhoods

Author(s):

Patients who self-identified as Black and were living in less affluent neighborhoods were less likely to be seen in one large memory clinic as well as have more severe dementia at initial visit.

Albert M. Lai, PhD

New research from an observational cross-sectional, single-center study published in Neurology showed that Black patients from less affluent neighborhoods were underrepresented in the clinic and had more severe dementia at their initial visit. These results suggest that Black patients with a lower socioeconomic status are less likely to be seen in memory clinics, which are an important access setting for any new available treatments for Alzheimer disease (AD).^1,2

All told, the study revealed that Black patients who lived in less advantaged neighborhoods were more likely to have moderate or severe dementia at their initial visit (OR, 1.59; 95% CI, 1.11 - 2.25) than White individuals. At the initial visit, 40% of Black patients (n = 217) and 31% of White patients (n = 1284) had mild dementia or worse. Notably, at the same time, 16% (n = 86) of Black patients and 10% of White patients (n =428) had moderate or severe dementia.

“Our results are concerning, especially since these clinics are likely to be a major point of access for new Alzheimer treatments as they become available,” senior author Albert M. Lai, PhD, professor of medicine in the Division of General Medical Sciences at Washington University School of Medicine in St. Louis, said in a statment.¹ “While we studied 1 memory clinic, if additional research finds similar disparities in other memory clinics, then these differences in access could worsen existing health care disparities.”

Investigators studied the association of a memory clinic and neighborhood-level measures of socioeconomic factors as well as the intersectionality of race. In the study, 4824 patients from a specialty memory care clinic at Washington University in St. Louis over 10 years were recruited, with 11% (n = 543) identifying as Black and 89% (n = 4281) as nonHispanic White. Severity of dementia at first evaluation at the clinic was measured using the Clinical Dementia Rating.

Researchers collected home addresses and used the Area Deprivation Index with them to identify if a patient lived in an advantaged or disadvantaged neighborhood. The index has information regarding socioeconomic conditions of each neighborhood and the residents. Thus, the index ranked neighborhoods based on 17 indicators including income, employment, education, and housing quality. The higher the score on this index demonstrated more of a neighborhood disadvantage for a patient.

In the analysis, patients seen at the clinic were more likely to live in more advantaged neighborhoods, having an average score of 45 on the index compared with an average score of 65 for the entire population in the service area. Black patients made up 11% of those seen in the clinic compared with 16% of those living in the clinic’s service area (P <.001). Notably, Black people were 59% more likely to have moderate to severe dementia at their initial evaluation compared White individuals following the adjustment for age, sex, and area deprivation index.

“This study provides additional motivation for addressing disparities that are likely to affect patient care,” Lai said in a statement.¹“Initiatives may include increased outreach to less affluent and more diverse neighborhoods, reducing requirements for scheduling an initial appointment, and hiring more doctors from diverse backgrounds.”

Lai also noted that research studies often recruit patients from large clinics which reduces the use of these clinics by underserved groups. Including these patients could improve the efforts for studies to be more inclusive. All told, only 1 memory clinic was studied in this analysis and therefore, it is unknown whether there are similar disparities that exist at other memory clinics for the same patient population.

REFERENCES
1. Study finds Black people less likely to be seen at memory clinic than white people. News Release. American Academy of Neurology. Published August 2, 2023. Accessed September 26, 2023. https://www.aan.com/PressRoom/Home/PressRelease/5106
2. Lewis A, Gupta A, Oh I, et al. The Association Between Socioeconomic Factors, Race, and Usage of a Specialty Memory Clinic. Neurology. 2023;10.1212/WNL.0000000000207674. doi:10.1212/WNL.0000000000207674