Dementia Attributable Healthcare Utilizations in the Caribbean versus United States

Article type: Research Article

Authors: Li, Jing^{a; *} | Weiss, Jordan^b | Rajadhyaksha, Ashish^c | Acosta, Daisy^d | Harrati, Amal^e | Jiménez Velázquez, Ivonne Z.^f | Liu, Mao-Mei^g | Guerra, Jorge J. Llibre^h | Rodriguez, Juan de Jesús Llibreⁱ | Dow, William H.^{g; j}

Affiliations: [a] The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA | [b] Stanford Center on Longevity, Stanford University, Stanford, CA, USA | [c] New York-Presbyterian Hospital, New York, NY, USA | [d] Universidad Nacional Pedro Henriquez Ureña (UNPHU), Santo Domingo, Dominican Republic | [e] Mathematica Policy Research, Oakland, CA, USA | [f] Department of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA | [g] Department of Demography, University of California at Berkeley, Berkeley, CA, USA | [h] Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA | [i] Medical University of Havana, Havana, Cuba | [j] School of Public Health, University of California at Berkeley, Berkeley, CA, USA

Correspondence: [*] Correspondence to: Jing Li, PhD, MA, The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, 1959 NE Pacific St, Magnuson Health Sciences Center, Seattle, WA 98195-7630, USA. Tel.: +1 650 862 8801; E-mail: jli0321@uw.edu.

Abstract: Background:Despite the high burden of Alzheimer’s disease and other dementias among the Hispanic population worldwide, little is known about how dementia affects healthcare utilizations among this population outside of the US, in particular among those in the Caribbean region. Objective:This study examines healthcare utilization associated with Alzheimer’s disease and other dementias among older adults in the Caribbean as compared to the US. Methods:We conducted harmonized analyses of two population-based surveys, the 10/66 Dementia Group Research data collected in Dominican Republic, Cuba, and Puerto Rico, and the US-based Health and Retirement Study. We examined changes in hospital nights and physician visits in response to incident and ongoing dementias. Results:Incident dementia significantly increased the risk of hospitalization and number of hospital nights in both populations. Ongoing dementia increased the risk of hospitalization and hospital nights in the US, with imprecise estimates for the Caribbean. The number of physician visits was elevated in the US but not in the Caribbean. Conclusions:The concentration of increased healthcare utilization on hospital care and among patients with incident dementia suggests an opportunity for improved outpatient management of new and existing dementia patients in the Caribbean.

Keywords: Alzheimer’s disease, Caribbean, dementia, healthcare utilization, Hispanics

DOI: 10.3233/JAD-230505

Journal: Journal of Alzheimer's Disease, vol. 96, no. 2, pp. 801-811, 2023