Inequities in dementia diagnosis and care: insights from a universal health care system
Bibliographic record
Abstract
INTRODUCTION: Burgeoning literature reports inequities in dementia diagnosis and care; evidence from a universal health care system using a comprehensive set of indicators and an intersectional approach is lacking. METHODS: We conducted a repeated yearly cohort study of community-dwelling people in Quebec with incident dementia (2000-2017). We described dementia diagnosis and 23 indicators of health service use and mortality across levels of material deprivation, derived from a validated ecological index based on the average income, employment, and education of residential neighborhoods. We then conducted preliminary description of patterns of primary care use across material deprivation and a neighborhood racialization index, derived from a census question around self-identification as visible minority. RESULTS: Of the 193,834 community-dwelling people with a new diagnosis of dementia, around 20% belonged to each material deprivation category. Age-standardised rates of 15/23 indicators differed across SES. People from most deprived areas had more hospitalisations, emergency department visits, potentially inappropriate medication prescriptions, and higher 1-year mortality, though they had higher care continuity. Conversely, rates were comparable across groups for the prescription of dementia-specific medications, and primary care visits. Patterns of primary care use varied across material deprivation and neighborhood racialization; with higher use in wealthiest neighborhoods, the highest use being in the most racialized ones. DISCUSSION: Despite global findings of higher dementia incidence in lower SES, we found similar incidence across SES. These findings indicate that there is likely severe under-diagnosis of dementia in more materially deprived neighborhoods. Stark differences across SES in service use by people with dementia may indicate different health needs and/or allude to pervasive health inequities. An intersectional lens allows for a nuanced description of inequalities. These results can inform policies to offer equitable, appropriate, and needs-based care to all people living with dementia.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.001 | 0.005 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".