Ethnic Variations in Prognosis of Patients with Dementia: A Prospective Nationwide Registry Linkage Study in The Netherlands

Article type: Research Article

Authors: Agyemang, Charles^{a; *} | van de Vorst, Irene E.^{b; c} | Koek, Huiberdina L.^c | Bots, Michiel L.^b | Seixas, Azizi^d | Norredam, Marie^{e; f} | Ikram, Umar^a | Stronks, Karien^a | Vaartjes, Ilonca^b

Affiliations: [a] Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands | [b] Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands | [c] Department of Geriatrics, University Medical Center Utrecht, Utrecht, The Netherlands | [d] Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY, USA | [e] Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark | [f] Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark

Correspondence: [*] Correspondence to: Dr. Charles Agyemang, Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Tel.: +31 20 5664885; Fax: +31 20 6972316; E-mail: [email protected].

Abstract: Background: Data on dementia prognosis among ethnic minority groups are limited in Europe. Objective: We assessed differences in short-term (1-year) and long-term (3-year) mortality and readmission risk after a first hospitalization or first ever referral to a day clinic for dementia between ethnic minority groups and the ethnic Dutch population in the Netherlands Methods: Nationwide prospective cohorts of first hospitalized dementia patients (N = 55,827) from January 1, 2000 to December 31, 2010 were constructed. Differences in short-term and long-term mortality and readmission risk following hospitalization or referral to the day clinic between ethnic minority groups (Surinamese, Turkish, Antilleans, Indonesians) and the ethnic Dutch population were investigated using Cox proportional hazard regression models with adjustment for age, sex, and comorbidities. Results: Age-sex-adjusted short-term and long-term risks of death following a first hospitalization with dementia were comparable between the ethnic minority groups and the ethnic Dutch. Age- and sex-adjusted risk of admission was higher only in Turkish compared with ethnic Dutch (HR 1.57, 95% CI,1.08–2.29). The difference between Turkish and the Dutch attenuated and was no longer statistically significant after further adjustment for comorbidities. There were no ethnic differences in short-term and long-term risk of death, and risk of readmission among day clinic patients. Conclusion: Compared with Dutch patients with a comparable comorbidity rate, ethnic minority patients with dementia did not have a worse prognosis. Given the poor prognosis of dementia, timely and targeted advance care planning is essential, particularly in ethnic minority groups who are mired by cultural barriers and where uptake of advance care planning is known to be low.

Keywords: Dementia, ethnic minority groups, ethnicity, Netherlands

DOI: 10.3233/JAD-160897

Journal: Journal of Alzheimer's Disease, vol. 56, no. 1, pp. 205-213, 2017