Influence of Education and Income on Receipt of Dementia Care in Sweden Show others and affiliations
2021 (English) In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 22, no 10, p. 2100-2107Article in journal (Refereed) Published
Sustainable development Sustainable Development
Abstract [en]
Objective: To explore the dementia diagnostic process and drug prescription for persons with dementia (PWD) with different socioeconomic status (SES). Design: Register-based cohort study. Setting and Participants: This study included 74,414 PWD aged ≥65 years from the Swedish Dementia Register (2007–2018). Their data were linked with the Swedish Longitudinal Integrated Database for Health Insurance and Labor Market Studies (2006–2017) to acquire the SES information 1 year before dementia diagnosis. Methods: Education and income—2 traditional SES indicators—were divided into 5 levels. Outcomes comprised the dementia diagnostic examinations, types of dementia diagnosis, diagnostic unit, and prescription of antidementia drugs. Binary logistic regression was performed to evaluate socioeconomic inequalities. Results: Compared to PWD with the lowest educational level, PWD with the highest educational level had a higher probability of receiving the basic diagnostic workup [odds ratio (OR) 1.19, 95% confidence interval (CI) 1.10-1.29], clock test (OR 1.12, 95% CI 1.02-1.24) and neuroimaging (OR 1.23, 95% CI 1.09-1.39). Compared with PWD in the lowest income quintile, PWD in the highest income quintile presented a higher chance of receiving the basic diagnostic workup (OR 1.35, 95% CI 1.26-1.46), clock test (OR 1.40, 95% CI 1.28-1.52), blood analysis (OR 1.21, 95% CI 1.06-1.39), Mini-Mental State Examination (OR 1.47, 95% CI 1.26-1.70), and neuroimaging (OR 1.30, 95% CI 1.18-1.44). PWD with higher education or income had a higher likelihood of obtaining a specified dementia diagnosis or being diagnosed at a memory clinic. SES presented no association with prescription of antidementia medication, except for the association between education and the use of memantine. Conclusions and Implications: Higher education or income was significantly associated with higher chance of receiving dementia diagnostic examinations, a specified dementia diagnosis, being diagnosed at a memory clinic, and using memantine. Socioeconomic inequalities in dementia diagnostic process and prescription of memantine occurred among PWD with different education or income levels.
Place, publisher, year, edition, pages Elsevier, 2021. Vol. 22, no 10, p. 2100-2107
Keywords [en]
Dementia, diagnosis, drug, education, income, socioeconomic
National Category
Public Health, Global Health and Social Medicine
Identifiers URN: urn:nbn:se:hj:diva-54234 DOI: 10.1016/j.jamda.2021.06.018 ISI: 000703174500022 PubMedID: 34280361 Scopus ID: 2-s2.0-85111059476 Local ID: HOA;;757468 OAI: oai:DiVA.org:hj-54234 DiVA, id: diva2:1585032
Funder Forte, Swedish Research Council for Health, Working Life and Welfare, 2017-01646 Stiftelsen Sigurd och Elsa Goljes minne
2021-08-162021-08-162025-02-20 Bibliographically approved