Investigators noted medication prescription disparities among patients with dementia despite factoring for age and sex.
Black patients with dementia did not receive major types of outpatient medication as frequently as White patients, according to research that will be presented at the 75th Annual Meeting of the American Academy of Neurology at the end of April 2023. Black patients were found to be 2-times less likely to receive major medications, such as benzodiazepines, and were prescribed cholinesterase inhibitors 10% less frequently than White patients, according to the study.
Racial disparities cause inequitable access to beneficial medications for patients in nursing homes and hospitals, Alice Hawkins, MD, Mount Sinai, New York, and member of the American Academy of Neurology, said in a recent press release. The study also found racial disparities in the use of dementia medication for patients at home.
“We hope our findings lead to a better understanding of these disparities so that steps can be taken to eliminate this health inequity,” Hawkins said.
Investigators conducted a study, enrolling 25,930 people, of whom 3655 individuals were Black and 12,885 were White, to understand the frequency that patients with dementia received 1 or more of 5 outpatient medication classes.
Medications include cholinesterase inhibitors to prevent the breakdown of acetylcholine, a chemical messenger that plays a significant role in memory, thought, and nerve cell communication processes; N-methyl-D-aspartate (NMDA) antagonists to improve cognitive function and improve communication between nerve cells in the brain; selective serotonin reuptake inhibitors (SSRIs) to treat depression; antipsychotics that treat psychosis; and benzodiazepines for anxiety and agitation.
Despite controlling for factors including age, sex, and insurance, Black patients were not prescribed medication for dementia as frequently as patients who are White. Professionals who prescribe cholinesterase inhibitors did so for 20% of Black patients with dementia, although they prescribed it to 30% of White patients. Additionally, 10% of Black patients receive an NMDA antagonist, compared to 17% of White patients; however, this gap was less severe for all patients who saw a neurologist, according to the study.
“Black people who saw a neurologist were receiving cholinesterase inhibitors and NMDA antagonists at rates more comparable to white people,” Hawkins said in the press release. “Therefore, referrals to specialists such as neurologists may decrease the disparities for these prescriptions.”
Black patients still received prescriptions for SSRIs, antipsychotics, and benzodiazepines at a lower rate that White patients. Percentages were 24% compared to 40%, 18% compared to 22%, and 18% compared to 37%, respectively.
The study contains some limitations, the first of which being that the data were limited to participant medical records. Additionally, the data did not contain any information on the physician’s prescribing behaviors, which makes it difficult to assess the proportion of physicians who prescribed fewer medications to Black patients versus other patient-related factors, according to the study authors.
“More research is needed to understand the root cause of such disparities and design programs to eliminate them,” Hawkins said.
American Academy of Neurology. Black people less likely to receive dementia-related medications. News Release. February 26, 2023. Accessed February 26, 2023. https://www.eurekalert.org/news-releases/980437