Black people and people living in less affluent neighborhoods-;areas with higher poverty levels and fewer educational and employment opportunities-; may be less likely to be seen at a memory care clinic compared to white people and people living in neighborhoods with fewer disadvantages, according to new research published in the August 2, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology.
Our results are concerning, especially since these clinics are likely to be a major point of access for new Alzheimer's treatments as they become available. While we studied one memory clinic, if additional research finds similar disparities in other memory clinics, then these differences in access could worsen existing health care disparities."
Albert M. Lai, PhD, Study Author, Washington University in St. Louis in Missouri
For the study, researchers looked at 4,824 people seen at a specialty memory care clinic at Washington University in St. Louis over 10 years. Of the total participants, 543, or 11%, were Black people and 4,281, or 89%, were non-Hispanic white people.
Researchers looked at the severity of dementia when people were first evaluated at the clinic.
Researchers used home addresses and a measure called the Area Deprivation Index to determine if each participant lived in an advantaged or disadvantaged neighborhood. The index incorporates information on the socioeconomic conditions of each neighborhood and its residents, ranking neighborhoods based on 17 indicators including income, employment, education and housing quality. Higher scores on this index indicate more neighborhood disadvantage.
People seen at the clinic were more likely to live in more advantaged neighborhoods, with patients having an average score of 45 on the area deprivation index, compared to an average score of 65 for the entire population in the service area.
Researchers found that Black people were underrepresented in the clinic. Black people made up 11% of those seen in the clinic, compared to 16% of those living in the clinic's service area.
They also found that Black people were more likely to have more advanced dementia at their first visit to the memory clinic compared to white people. At their initial visit, 40% of Black people and 31% of white people had mild dementia or worse and 16% of Black people and 10% of white people had moderate or severe dementia.
After adjusting for age, sex, and area deprivation index, Black people were 59% more likely to have moderate to severe dementia at their initial evaluation than white people.
"This study provides additional motivation for addressing disparities that are likely to affect patient care," Lai said. "Initiatives may include increased outreach to less affluent and more diverse neighborhoods, reducing requirements for scheduling an initial appointment, and hiring more doctors from diverse backgrounds."
Lai noted that since research studies often recruit participants from large clinics, reduced use of these clinics by underserved groups could hamper efforts to make studies more inclusive.
A limitation of the study was that only one memory clinic was studied, so it is unknown whether similar disparities exist at other memory clinics.
The study was supported by Cure Alzheimer's Fund.
Lewis, A., et al. (2023). The Association Between Socioeconomic Factors, Race, and Usage of a Specialty Memory Clinic. Neurology. doi.org/10.1212/WNL.0000000000207674.