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Hinton L, Tran D, Peak K, Meyer OL, Quiñones AR. Mapping racial and ethnic healthcare disparities for persons living with dementia: A scoping review. Alzheimers Dement 2024; 20:3000-3020. [PMID: 38265164 PMCID: PMC11032576 DOI: 10.1002/alz.13612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/25/2023] [Accepted: 11/25/2023] [Indexed: 01/25/2024]
Abstract
INTRODUCTION We set out to map evidence of disparities in Alzheimer's disease and Alzheimer's disease related dementias healthcare, including issues of access, quality, and outcomes for racial/ethnic minoritized persons living with dementia (PLWD) and family caregivers. METHODS We conducted a scoping review of the literature published from 2000 to 2022 in PubMed, PsycINFO, and CINAHL. The inclusion criteria were: (1) focused on PLWD and/or family caregivers, (2) examined disparities or differences in healthcare, (3) were conducted in the United States, (4) compared two or more racial/ethnic groups, and (5) reported quantitative or qualitative findings. RESULTS Key findings include accumulating evidence that minoritized populations are less likely to receive an accurate and timely diagnosis, be prescribed anti-dementia medications, and use hospice care, and more likely to have a higher risk of hospitalization and receive more aggressive life-sustaining treatment at the end-of-life. DISCUSSION Future studies need to examine underlying processes and develop interventions to reduce disparities while also being more broadly inclusive of diverse populations.
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Affiliation(s)
- Ladson Hinton
- School of MedicineUniversity of CaliforniaDavisSacramentoCaliforniaUSA
| | - Duyen Tran
- School of MedicineUniversity of CaliforniaDavisSacramentoCaliforniaUSA
| | - Kate Peak
- Department of Family MedicineOregon Health & Science University (OHSU)PortlandOregonUSA
| | - Oanh L. Meyer
- School of MedicineUniversity of CaliforniaDavisSacramentoCaliforniaUSA
| | - Ana R. Quiñones
- Department of Family MedicineOregon Health & Science University (OHSU)PortlandOregonUSA
- OHSU‐PSU School of Public HealthOregon Health & Science UniversityPortlandOregonUSA
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Bowblis JR, Akosionu O, Ng W, Shippee TP. Identifying Nursing Homes With Diverse Racial and Ethnic Resident Compositions: The Importance of Group Heterogeneity and Geographic Context. Med Care Res Rev 2023; 80:175-186. [PMID: 36408838 DOI: 10.1177/10775587221134870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Racial/ethnic composition of nursing home (NH) plays a particularly important role in NH quality. A key methodological issue is defining when an NH serves a low versus high proportion of racially/ethnically diverse residents. Using the Minimum Data Set from 2015 merged with Certification and Survey Provider Enhanced Reports, we calculated the racial/ethnic composition of U.S.-based NHs for Black or Hispanic residents specifically, and a general Black, Indigenous, and People of Color (BIPOC) grouping for long-stay residents. We examined different definitions of having a high racial/ethnic composition by varying percentile thresholds of composition, state-specific and national thresholds, and restricting composition to BIPOC residents as well as only Black and Hispanic residents. NHs with a high racial/ethnic composition have different facility characteristics than the average NH. Based on this, we make suggestions for how to identify NHs with diverse racial/ethnic resident compositions.
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Affiliation(s)
| | | | - Weiwen Ng
- University of Minnesota, Twin Cities, Minneapolis, USA
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Zuo SW, Ackenbom MF, Harris J. Racial Differences in Urinary Catheter Use Among Female Nursing Home Residents. Urology 2023; 172:105-110. [PMID: 36481201 PMCID: PMC9928770 DOI: 10.1016/j.urology.2022.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/15/2022] [Accepted: 11/20/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess racial differences in prevalence of indwelling urinary catheterization and intermittent catheterization among female NH residents in the United States (US). METHODS We performed a cross-sectional analysis using the 2019 Minimum Data Set 3.0 and developed a multivariable logistic regression model to examine the association between catheter use and race. Moderation analyses were performed to clarify significant associations. RESULTS Our study cohort was composed of 597,966 women, who were predominantly of White race with a median age of 80 years. Eight percent (n=47,799) of female residents had indwelling catheters, and 0.5% (n=2,876) used intermittent catheterization. Black residents had a 7% lower odds of having an indwelling catheter (aOR 0.93, 95% CI 0.90-0.96), and a 38% lower odds of utilizing intermittent catheterization (aOR 0.62, 95% CI 0.54-0.71) compared to White residents when controlling for common factors associated with catheter use. In moderation analyses, Black residents with age under 80 years and BMI of 35 kg/m2 or greater were less likely to have an indwelling catheter than age- and BMI-matched White residents. CONCLUSION Racial differences in both indwelling and intermittent catheterization prevalence exist in female NH residents. These disparities should be further clarified to reduce bias in NH care.
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Affiliation(s)
- Stephanie W Zuo
- Division of Urogynecology and Pelvic Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Mary F Ackenbom
- Division of Urogynecology and Pelvic Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA
| | - John Harris
- Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA; Department of Obstetrics and Gynecology, University of Pittsburgh Medical Center, Pittsburgh, PA
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Nalls V, Galik E, Klinedinst NJ, Barr E, Brandt N, Lerner N, Resnick B. Racial Differences in Antidepressant Use in Nursing Facility Residents With Moderate to Severe Cognitive Impairment. Sr Care Pharm 2022; 37:448-457. [PMID: 36039002 DOI: 10.4140/tcp.n.2022.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective To describe and compare the use of antidepressants between Black or African descent and White nursing facility residents with moderate to severe cognitive impairment. Design This was a secondary data analysis using baseline data from the Function and Behavior Focused Care for Nursing Facility Residents with Dementia randomized control trial. Setting Participants were recruited from 10 urban and two rural nursing facilities from Maryland. Methods Participants had to be 55 years of age or older, English-speaking, reside in long-term care at time of recruitment, and score a 15 or less on the Mini Mental-State Examination. A total of 336 residents participated at baseline. Data were collected by a research evaluator through observation, proxy report from staff caring for the resident the day of testing, and patient charts. Main Outcomes A significant difference of antidepressant use between Black or African descent and White nursing facility residents with moderate to severe cognitive impairment would be noted when controlling for depression, age, gender, functional status, agitation, and number of co-morbidities. Results In adjusted models, Black or African descent residents were less likely to be prescribed antidepressants compared with White residents. Conclusion Racial differences were noted regarding antidepressant use among nursing facility residents with moderate to severe cognitive impairment, but it is unknown if race could impact prescribing practices when indications for use are known. Further research is needed to ascertain if knowing the specific indications for use might contribute to racial disparities with antidepressant prescribing in nursing facility residents with moderate to severe cognitive impairment.
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Affiliation(s)
- Victoria Nalls
- 1 School of Nursing, University of Maryland, Baltimore, Maryland
| | - Elizabeth Galik
- 1 School of Nursing, University of Maryland, Baltimore, Maryland
| | | | - Erik Barr
- 1 School of Nursing, University of Maryland, Baltimore, Maryland
| | - Nicole Brandt
- 2 School of Pharmacy, University of Maryland, Baltimore, Maryland
| | - Nancy Lerner
- 1 School of Nursing, University of Maryland, Baltimore, Maryland
| | - Barbara Resnick
- 1 School of Nursing, University of Maryland, Baltimore, Maryland
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Orth J, Li Y, Simning A, Zimmerman S, Temkin-Greener H. End-of-Life Care among Nursing Home Residents with Dementia Varies by Nursing Home and Market Characteristics. J Am Med Dir Assoc 2021; 22:320-328.e4. [PMID: 32736989 PMCID: PMC7855379 DOI: 10.1016/j.jamda.2020.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/30/2020] [Accepted: 06/05/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Nursing homes (NHs) are critical end-of-life (EOL) care settings for 70% of Americans dying with Alzheimer's disease/related dementias (ADRD). Whether EOL care/outcomes vary by NH/market characteristics for this population is unknown but essential information for improving NH EOL care/outcomes. Our objectives were to examine variations in EOL care/outcomes among decedents with ADRD and identify associations with NH/market characteristics. DESIGN Cross-sectional. OUTCOMES Place-of-death (hospital/NH), presence of pressure ulcers, potentially avoidable hospitalizations (PAHs), and hospice use at EOL. Key covariates were ownership, staffing, presence of Alzheimer's units, and market competition. SETTING AND PARTICIPANTS Long-stay NH residents with ADRD, age 65 + years of age, who died in 2017 (N = 191,435; 14,618 NHs) in NHs or hospitals shortly after NH discharge. METHODS National Medicare claims, Minimum Data Set, public datasets. Descriptive analyses and multivariable logistic regressions. RESULTS As ADRD severity increased, adjusted rates of in-hospital deaths and PAHs decreased (17.0% to 6.3%; 11.2% to 7.0%); adjusted rates of dying with pressure ulcers and hospice use increased (8.2% to 13.5%; 24.5% to 40.7%). Decedents with moderate and severe ADRD had 16% and 13% higher likelihoods of in-hospital deaths in for-profit NHs. In NHs with Alzheimer's units, likelihoods of in-hospital deaths, dying with pressure ulcers, and PAHs were significantly lower. As ADRD severity increased, higher licensed nurse staffing was associated with 14%‒27% lower likelihoods of PAHs. Increased NH market competition was associated with higher likelihood of hospice use, and lower likelihood of in-hospital deaths among decedents with moderate ADRD. CONCLUSIONS AND IMPLICATIONS Decedents with ADRD in NHs that were nonprofit, had Alzheimer's units, higher licensed nurse staffing, and in more competitive markets, had better EOL care/outcomes. Modifications to state Medicaid NH payments may promote better EOL care/outcomes for this population. Future research to understand NH care practices associated with presence of Alzheimer's units is warranted to identify mechanisms possibly promoting higher-quality EOL care.
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Affiliation(s)
- Jessica Orth
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY.
| | - Yue Li
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Adam Simning
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Sheryl Zimmerman
- The Cecil G. Sheps Center for Health Services Research and The Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
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Bowblis JR, Ng W, Akosionu O, Shippee TP. Decomposing Racial and Ethnic Disparities in Nursing Home Quality of Life. J Appl Gerontol 2020; 40:1051-1061. [PMID: 32772869 DOI: 10.1177/0733464820946659] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study examines the racial/ethnic disparity among nursing home (NH) residents using a self-reported, validated measure of quality of life (QoL) among long-stay residents in Minnesota. Blinder-Oaxaca decomposition techniques determine which resident and facility factors are the potential sources of the racial/ethnic disparities in QoL. Black, Indigenous, and other People of Color (BIPOC) report lower QoL than White residents. Facility structural characteristics and being a NH with a high proportion of residents who are BIPOC are the factors that have the largest explanatory share of the disparity. Modifiable characteristics like staffing levels explain a small share of the disparity. To improve the QoL of BIPOC NH residents, efforts need to focus on addressing systemic disparities for NHs with a high proportion of residents who are BIPOC.
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Affiliation(s)
| | - Weiwen Ng
- University of Minnesota, Minneapolis, USA
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Shippee TP, Ng W, Bowblis JR. Does Living in a Higher Proportion Minority Facility Improve Quality of Life for Racial/Ethnic Minority Residents in Nursing Homes? Innov Aging 2020; 4:igaa014. [PMID: 32529052 PMCID: PMC7272785 DOI: 10.1093/geroni/igaa014] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Indexed: 11/12/2022] Open
Abstract
Background and Objectives The proportion of racial/ethnic minority older adults in nursing homes (NHs) has increased dramatically and will surpass the proportion of white adults by 2030.Yet, little is known about minority groups’ experiences related to the quality of life (QOL). QOL is a person-centered measure, capturing multiple aspects of well-being. NH quality has been commonly measured using clinical care indicators, but there is growing recognition for the need to include QOL. This study examines the role of individual race/ethnicity, facility racial/ethnic composition, and the interaction of both for NH resident QOL. Research Design and Methods We used a unique state-level data set that includes self-reported QOL surveys with a random sample of long-stay Minnesota NH residents, using a multidimensional measure of QOL. These surveys were linked to resident clinical data from the Minimum Dataset 3.0 and facility-level characteristics. Minnesota is one of the two states in the nation that collects validated QOL measures, linked to data on resident and detailed facility characteristics. We used mixed-effects models, with random intercepts to model summary QOL score and individual domains. Results We identified significant racial disparities in NH resident QOL. Minority residents report significantly lower QOL scores than white residents, and NHs with higher proportion minority residents have significantly lower QOL scores. Minority residents have significantly lower adjusted QOL than white residents, whether they are in low- or high-minority facilities, indicating a remaining gap in individual care needs. Discussion and Implications The findings highlight system-level racial disparities in NH residents QOL, with residents who live in high-proportion minority NHs facing the greatest threats to their QOL. Efforts need to focus on reducing racial/ethnic disparities in QOL, including potential public reporting (similar to quality of care) and resources and attention to provision of culturally sensitive care in NHs to address residents’ unique needs.
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Affiliation(s)
- Tetyana P Shippee
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
| | - Weiwen Ng
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
| | - John R Bowblis
- Department of Economics, Farmer School of Business, Miami University, Oxford, Ohio
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Chisholm L, Zhang NJ, Hyer K, Pradhan R, Unruh L, Lin FC. Culture Change in Nursing Homes: What Is the Role of Nursing Home Resources? INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2018; 55:46958018787043. [PMID: 30015532 PMCID: PMC6050816 DOI: 10.1177/0046958018787043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Quality of care has been a long-standing issue in US nursing homes. The culture
change movement attempts to transition nursing homes from health care
institutions to person-centered homes. While the adoption of culture change has
been spreading across nursing homes, barriers to adoption persist. Nursing homes
that disproportionately serve minority residents may have additional challenges
implementing culture change compared with other facilities due to limited
financial and staffing resources. The objective of this study was to examine how
nursing home characteristics are associated with culture change adoption in
Central Florida nursing homes. This cross-sectional study included 81 directors
of nursing (DONs) who completed the Artifacts of Culture Change survey. In
addition, nursing home organizational data were obtained from the Certification
and Survey Provider Enhanced Reports (CASPER). A logistic regression was
conducted to examine the relationship between high culture change adoption and
nursing home characteristics. The overall adoption of culture change scores in
Central Florida nursing homes was low. Nevertheless, there was variability
across nursing homes in the adoption of culture change. High culture change
adoption was associated with nursing homes having lower proportions of Medicaid
residents.
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Affiliation(s)
| | | | | | - Rohit Pradhan
- 4 University of Arkansas for Medical Sciences, Little Rock, USA
| | - Lynn Unruh
- 1 University of Central Florida, Orlando, USA
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Rivera-Hernandez M, Kumar A, Epstein-Lubow G, Thomas KS. Disparities in Nursing Home Use and Quality Among African American, Hispanic, and White Medicare Residents With Alzheimer's Disease and Related Dementias. J Aging Health 2018; 31:1259-1277. [PMID: 29717902 DOI: 10.1177/0898264318767778] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: This article examines differences in nursing home use and quality among Medicare beneficiaries, in both Medicare Advantage and fee-for-service, newly admitted to nursing homes with Alzheimer's disease and related dementias (ADRD). Method: Retrospective, national, population-based study of Medicare residents newly admitted to nursing homes with ADRD by race and ethnic group. Our analytic sample included 1,302,099 nursing home residents-268,181 with a diagnosis of ADRD-in 13,532 nursing homes from 2014. Results: We found that a larger share of Hispanic Medicare residents that are admitted to nursing homes have ADRD compared with African American and White beneficiaries. Both Hispanics and African Americans with ADRD received care in segregated nursing homes with fewer resources and lower quality of care compared with White residents. Discussion: These results have implications for targeted efforts to achieve health care equity and quality improvement efforts among nursing homes that serve minority patients.
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Affiliation(s)
| | | | - Gary Epstein-Lubow
- 1 Brown University, Providence, RI, USA.,2 Center for Alzheimer's Disease and Memory Care Hebrew SeniorLife, Boston, MA, USA
| | - Kali S Thomas
- 1 Brown University, Providence, RI, USA.,3 Providence VA Medical Center, RI, USA
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Shippee TP, Henning-Smith C, Rhee TG, Held RN, Kane RL. Racial Differences in Minnesota Nursing Home Residents' Quality of Life: The Importance of Looking Beyond Individual Predictors. J Aging Health 2015; 28:199-224. [PMID: 26112065 DOI: 10.1177/0898264315589576] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The aim of this study is to investigate racial differences in nursing home (NH) residents' quality of life (QOL) at the resident and facility levels. METHOD We used hierarchical linear modeling to identify significant resident- and facility-level predictors for racial differences in six resident-reported QOL domains. Data came from the following: (a) resident-reported QOL (n = 10,929), (b) the Minimum Data Set, and (c) facility-level characteristics from the Minnesota Department of Human Services (n = 376). RESULTS White residents reported higher QOL in five of six domains, but in full models, individual-level racial differences remained only for food enjoyment. On the facility level, higher percentage of White residents was associated with better scores in three domains, even after adjusting for all characteristics. DISCUSSION Racial differences in QOL exist on individual and aggregate levels. Individual differences are mainly explained by health status. The finding that facility racial composition predicts QOL more than individual race underscores the importance of examining NH structural characteristics and practices.
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Affiliation(s)
| | | | | | - Robert N Held
- Minnesota Department of Human Services, Minneapolis, USA
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Sentell TL, Valcour N, Ahn HJ, Miyamura J, Nakamoto B, Chow D, Masaki K, Seto TB, Chen JJ, Shikuma C. High rates of Native Hawaiian and older Japanese adults hospitalized with dementia in Hawai'i. J Am Geriatr Soc 2015; 63:158-64. [PMID: 25537987 PMCID: PMC4300272 DOI: 10.1111/jgs.13182] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Data on dementia in Native Hawaiians and many Asian subgroups in the United States are limited. Inpatients with dementia have higher costs, longer stays, and higher mortality than those without dementia. This study compared rates of inpatients with a dementia diagnosis for disaggregated Asian and Pacific Islanders (Native Hawaiian, Chinese, Japanese, Filipino) with those of whites according to age (18-59, 60-69, 70-79, 80-89, ≤90) for all adults hospitalized in Hawai'i between December 2006 and December 2010; 13,465 inpatients with a dementia diagnosis were identified using International Classification of Diseases, Ninth Revision, codes. Rates were calculated using population size denominators derived from the U.S. Census. In all age categories, Native Hawaiians had the highest unadjusted rates of inpatients with dementia and were more likely to have a dementia diagnosis at discharge at younger ages than other racial and ethnic groups. In adjusted models (controlling for sex, residence location, and insurer), Native Hawaiian inpatients aged 18 to 59 (aRR = 1.50, 95% CI = 0.84-2.69), 60 to 69 (aRR = 2.53, 95% CI = 1.74-3.68), 70 to 79 (aRR = 2.19, 95% CI = 1.78-2.69), and 80 to 89 (aRR = 2.53, 95% CI = 1.24-1.71) were significantly more likely to have dementia than whites, as were Japanese aged 70 to 79 (aRR = 1.30, 95% CI = 1.01-1.67), 80 to 89 (aRR = 1.29, 95% CI = 1.05-1.57), and 90 and older (aRR = 1.51, 95% CI = 1.24-1.85). Japanese aged 18 to 59 had were significantly less likely to have dementia than whites (aRR = 0.40, 95% CI = 0.17-0.94). These patterns have important public health and clinical care implications for Native Hawaiians and older Japanese populations. Future studies should consider whether preventable medical risk, caregiving, socioeconomic conditions, genetic disposition, or a combination of these factors are responsible for these findings.
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Affiliation(s)
- Tetine L Sentell
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, Hawai'i
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