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Racial and ethnic differences in disease course Medicare expenditures for beneficiaries with dementia
Olchanski N, Zhu Y, Liang L, Cohen JT, Faul JD, Fillit HM, Freund KM, Lin PJ. Journal of the American Geriatrics Society, 2024-03-20
Topic: Risk, prevention and care in population studies
Background Research on racial and ethnic disparities in costs of care during the course of dementia is sparse. We analyzed Medicare expenditures for beneficiaries with dementia to identify when during the course of care costs are the highest and whether they differ by race and ethnicity. Methods We analyzed data from the 2000-2016 Health and Retirement Study (HRS) linked with corresponding Medicare claims to estimate total Medicare expenditures for four phases: (1) the year before a dementia diagnosis, (2) the first year following a dementia diagnosis, (3) ongoing care for dementia after the first year, and (4) the last year of life. We estimated each patient's phase-specific and disease course Medicare expenditures by using a race-specific survival model and monthly expenditures adjusted for patient characteristics. We investigated healthcare utilization by service type across races/ethnicities and phases of care. Results Adjusted mean total Medicare expenditures for non-Hispanic (NH) Black ($165,730) and Hispanic beneficiaries with dementia ($160,442) exceeded corresponding expenditures for NH Whites ($136,326). In the year preceding and immediately following initial dementia diagnosis, mean Medicare expenditures for NH Blacks ($26,337 and $20,429) exceeded expenditures for Hispanics and NH Whites ($21,399-23,176 and 17,182-18,244). The last year of life was responsible for the greatest cost contribution: $51,294 (NH Blacks), $47,469 (Hispanics), and $39,499 (NH Whites). These differences were driven by greater use of high-cost services (e.g., emergency department, inpatient and intensive care), especially during the last year of life. Conclusions NH Black and Hispanic beneficiaries with dementia had higher disease course Medicare expenditures than NH Whites. Expenditures were highest for NH Black beneficiaries in every phase of care. Further research should address mechanisms of such disparities and identify methods to improve communication, shared decision-making, and access to appropriate services for all populations.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Olchanski, N., Zhu, Y., Liang, L., Cohen, J. T., Faul, J. D., Fillit, H. M., et al. (2024). Racial and ethnic differences in disease course Medicare expenditures for beneficiaries with dementia. Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.18822
Vancouver
Olchanski N, Zhu Y, Liang L, Cohen JT, Faul JD, Fillit HM, et al. Racial and ethnic differences in disease course Medicare expenditures for beneficiaries with dementia. Journal of the American Geriatrics Society. 2024. doi:10.1111/jgs.18822. PMID: 38504583.
BibTeX
@article{olchanski2024-38504583,
author = {Olchanski, N. and Zhu, Y. and Liang, L. and Cohen, J. T. and Faul, J. D. and Fillit, H. M. and Freund, K. M. and Lin, P. J.},
title = {{Racial and ethnic differences in disease course Medicare expenditures for beneficiaries with dementia}},
journal = {Journal of the American Geriatrics Society},
year = {2024},
doi = {10.1111/jgs.18822},
pmid = {38504583},
url = {https://doi.org/10.1111/jgs.18822}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 8 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
Key findings
- Results Adjusted mean total Medicare expenditures for non-Hispanic (NH) Black ($165,730) and Hispanic beneficiaries with dementia ($160,442) exceeded corresponding expenditures for NH Whites ($136,326).
Why it matters
This cohort study found that adjusted mean total Medicare expenditures for non-Hispanic Black ($165,730) and Hispanic beneficiaries with dementia ($160,442) exceeded those for non-Hispanic White beneficiaries ($136,326). It documents racial and ethnic differences in Medicare expenditures during the dementia disease course rather than testing treatment, cure, or prevention.
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Study details
- Study designcohort
- Effect sizeDisease-course Medicare spending $165,730 (Black) and $160,442 (Hispanic) vs $136,326 (White)
- Evidence strengthModerate
Limitations
Claims-based algorithms for identifying dementia may introduce bias by race and ethnicity; documented delays in diagnosis for Black and Hispanic beneficiaries mean they enter the analysis later in their disease, so the disparities found are described by the authors as conservative underestimates.
How this study scored 53/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for sample size, studied in people and randomised / blinded because the record does not state it. We have no data on free to read, so that was left out: it earned 52 of the 98 points we could judge it on, which is 53 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of the American Geriatrics Society) |
| Journal's citation record | 3 / 4 | Journal of the American Geriatrics Society: journal h-index 344 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2024 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 10 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 2.5 citations a year over 4 year(s) since 2024 |
| Impact for its field and year | 2 / 6 | Cited 2.7× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 3 other studies in this library |
| Still being cited | 1 / 4 | Cited 10 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Pei‐Jung Lin: h-index 27 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of Michigan: institution h-index 2,240 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 5 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 38504583) |
| Free to read | — / 2 | Access not recorded — left out of this score |
| Points | 52 / 98 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 52 of the 98 points we could judge it on is 53 out of 100. |
| Total | 53 / 100 | — |
What each of these 20 components measures, and what this score is not →
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