Racial Disparities Exist in Prescribing Patterns for Managing Dementia

Health disparities have been observed in the prescribing patterns of all dementia-associated medications, with fewer prescriptions in the outpatient setting received by Black individuals compared with White individuals, according to study results presented at the 2023 American Academy of Neurology (AAN) Annual Meeting, held from April 22 to 27, in Boston, Massachusetts.

There are existing health disparities regarding the utilization of medications, such as selective serotonin reuptake inhibitors (SSRIs), cholinesterase inhibitors, and antipsychotics, to treat dementia among patients in hospitals and nursing homes. Limited data are available regarding inequalities in the use of these agents in the outpatient setting.

In the current retrospective study, researchers sought to explore disparities across racial and ethnic lines with respect to the utilization of medications for the management of dementia among outpatients. They obtained information on demographics, including self-reported race/ethnicity, medications prescribed, and referrals to specialists, among all individuals with a diagnosis of dementia who were seen at a multicenter academic health care institution.

Chi-square and logistic regression were used to compare the rates of use of a total of 5 medication classes — that is, SSRIs, cholinesterase inhibitors, antipsychotics, benzodiazepines, and N-methyl-D-aspartate (NMDA) antagonists — among individuals of different races and ethnicities, controlling for factors such as sex, age, marital status, primary language, type of insurance, and referrals to specialists.

Researchers found that Black individuals with dementia were treated with all 5 classes of medication significantly less often than White individuals, as follows (P <.001 for all):

• Cholinesterase inhibitors: 20.4% vs 30.0%, respectively
• NMDA antagonists: 10.2% vs 16.7%, respectively
• SSRIs: 23.9% vs 39.9%, respectively
• Antipsychotics: 18.0% vs 21.7%, respectively
• Benzodiazepines: 17.5% vs 36.8%, respectively

Per logistic regression analysis that controlled for confounders, the following findings were reported:

• Black individuals received all agents significantly less often than did White individuals
• White individuals received benzodiazepines significantly more often than did all racial/ethnic groups
• Black individuals had more referrals to specialists than did White individuals
• Black individuals who had neurology consultations received prescriptions for NMDA antagonists and cholinesterase inhibitors at comparable rates to their White counterparts

“Racial disparities exist in the prescription patterns of all dementia-related medications, with Black patients receiving prescriptions less frequently than White patients in the outpatient setting,” the researchers acknowledged. They concluded, “Referrals to specialists such as neurologists may decrease these [racial/ethnic] disparities. More research is needed to understand the root cause of such disparities and design programs to eliminate them.”