Racial and Ethnic Differences in the Cost of Dementia Care

Natalia Olchanski, Ph.D.

Alzheimer’s dementia is a huge financial burden to society with an estimated lifetime care cost as high as $377,621 per patient. This is more than twice the cost of someone without dementia, according to previous research published in Health Affairs.

To understand at what stage the disease costs are highest and if costs are determined by race and ethnicity, a research team led by Natalia Olchanski, Ph.D., from Tufts Medical Center in Boston, studied the average costs of Medicare beneficiaries from different racial and ethnic groups. Medicare is currently the largest payer for healthcare services for dementia patients.

Results were published today in the Journal of the American Geriatrics Society.

The team analyzed data from the 2000-2016 Health and Retirement Study that is linked with corresponding Medicare claims. Costs were measured during four periods: the year before dementia diagnosis, the first year following diagnosis, ongoing care after the first year and the last year of life. The average age of disease onset was 81 years old. Over half of enrollees (61%) were female.

Researchers found that Black and Hispanic dementia patients had the highest Medicare expenditures. On average, total expenditures were $165,730 for Black beneficiaries, $160,442 for Hispanic beneficiaries and $136,326 for white beneficiaries.

The main drivers of these differences were increased inpatient hospital services. Black beneficiaries had fewer ambulatory care visits and more emergency department visits at every stage studied. During the last year of life, they were also the most likely to be admitted to the ICU when compared to White beneficiaries.

Care disparities may also stem from the fact that within the first year of diagnosis, Blacks and Hispanics are less likely to have healthcare follow-up appointments, according to previous research published by the Alzheimer’s Association. This may be due to lack of information about disease progression, inability to attend appointments or preference for having the care of family members instead.

Costs were also the highest during the last year of life due to increased emergency room visits, intensive care services and inpatient visits. On average, expenditures for Blacks were $51,294, Hispanics were $47,469 and Whites were $39,499.

“Higher expenditures do not necessarily result in higher quality care or better outcomes,” Olchanski said in a news release. “It’s clear from our study that improvements are needed in all phases of care to enhance care management for people with dementia and reduce disparities for disadvantaged populations.”