Racial and ethnic patterns and differences in health care expenditures among Medicare beneficiaries with and without cognitive limitation or Alzheimer's disease and related dementias: a retrospective cohort study
Background: Numerous studies have documented racial and ethnic differences in the prevalence and incidence of Alzheimer's disease and related dementias (ADRD). Less is known, however, about racial and ethnic differences in health care expenditures among older adults at risk for ADRD (cognitive limitation without ADRD) or with ADRD. In particular, there is limited evidence that racial and ethnic differences in health care expenditures change over the trajectory of ADRD or differ by types of
... er by types of service.Methods: We examined racial and ethnic patterns and differences in health care expenditures (total health care expenditures, out-of-pocket expenditures, and six service-specific expenditures) among Medicare beneficiaries without cognitive limitation, those with cognitive limitation without ADRD, and those with ADRD. Using the 1996-2017 Medical Expenditure Panel Survey, we performed multivariable regression models to estimate expenditure differences among racial and ethnic groups without cognitive limitation, those with cognitive limitation without ADRD and those with ADRD. Models accounted for survey weights and adjusted for various demographic, socioeconomic, and health characteristics.Results: Asians, and Latinos without cognitive limitation had lower total health care expenditures than whites without cognitive limitation ($10236, $9497, $9597, and $11541, respectively), but there were no racial and ethnic differences in total health care expenditures among those with cognitive limitation without ADRD and those with ADRD. In all populations, however, blacks, Asians, and Latinos tended to have lower out-of-pocket expenditures than whites (except for Asians with cognitive limitation without ADRD). Furthermore, service-specific health care expenditures varied by racial and ethnic groups.Conclusions: Our findings may suggest that racial and ethnic minority groups did not experience limited access to care before and after ADRD diagnosis. Differences in out-of-pocket expenditures and service-specific expenditures may be attributable to racial and ethnic differences in care access and/or care preference based on family structure and cultural/economic factors. Particularly, heterogeneous patterns of service-specific expenditures by racial and ethnic groups underscore the importance of future research in identifying determinants leading to variations in service-specific expenditures among racial and ethnic groups.