Association Between Socioeconomic Factors, Race, and Use of a Specialty Memory Clinic
Abigail Lewis, Aditi Gupta, Inez Y. Oh, Suzanne E. Schindler, Nupur Ghoshal, Zachary B. Abrams, Randi E. Foraker, Barbara J. Snider, John C. Morris, Joyce E. Balls‐Berry, Mahendra Gupta, Philip Payne, Albert M. Lai
Abstract
<h3>Background and Objectives:</h3> The capacity of specialty memory clinics in the United States is very limited. If lower socioeconomic status or minoritized racial group is associated with reduced use of memory clinics, this could exacerbate healthcare disparities, especially if more effective treatments for Alzheimer disease become available. We aimed to understand how use of a memory clinic is associated with neighborhood-level measures of socioeconomic factors and the intersectionality of race. <h3>Methods:</h3> We conducted an observational cross-sectional study utilizing electronic health record data to compare the neighborhood advantage of patients seen at the Washington University Memory Diagnostic Center to the catchment area using a Geographical Information System. Further, we compared the severity of dementia at the initial visit between patients who self-identified as Black or White. We used a multinomial logistic regression model to assess the Clinical Dementia Rating<sup>®</sup> (CDR®) at the initial visit and t-tests to compare neighborhood characteristics including the Area Deprivation Index (ADI) to the catchment area. <h3>Results:</h3> 4,824 patients seen at the memory clinic between 2008-2018 were included in this study (mean age 72.7 [standard deviation 11.0] years, 2,712 [56%] female, 543 [11%] Black). Most of the memory clinic patients lived in more advantaged neighborhoods within the overall catchment area. The percentage of patients self-identifying as Black (11%) was lower than the average percentage of Black individuals by Census tract in the catchment area (16%) (<i>p</i> < 0.001). Black patients lived in less advantaged neighborhoods, and Black patients were more likely than White patients to have moderate or severe dementia at their initial visit (odds ratio, 1.59 [95% confidence interval, 1.11 – 2.25]). <h3>Discussion:</h3> This study demonstrates that patients living in less affluent neighborhoods were less likely to be seen in one large memory clinic. Black patients were under-represented in the clinic, and Black patients had more severe dementia at their initial visit. These findings suggest that patients with a lower socioeconomic status and who identify as Black are less likely to be seen in memory clinics, which are likely to be a major point of access for any new Alzheimer disease treatments that may become available.