Beaird H, Koroukian SM, Diaz M, Rimm AA; AcademyHealth. Meeting (2005 : Boston, Mass.).
Abstr AcademyHealth Meet. 2005; 22: abstract no. 4068.
Case Western Reserve University, Epidemiology & Biostatistics, 10900 Euclid Avenue, Cleveland, OH 44106 Tel. (216)368-3197 Fax (216)368-3970
RESEARCH OBJECTIVE: To determine if patients hospitalized with Alzheimer's disease and other associated types of dementia (A/D), undergo non-dementia related surgical treatments at a comparable rate as patients free from A/D. STUDY DESIGN: Using 1984 through 1997 MedPAR (Medicare Provider Analysis and Review) data, two cohorts of non-Hispanic white men were identified and followed longitudinally. Hospitalization records were searched as far back as 1984 to exclude patients with a previous diagnosis of A/D. Patients hospitalized with A/D for the first time in 1992 constituted the A/D group, while all others made up the non-A/D group. Patients were then followed through 1997 to determine the rates of prostatectomy, cholecystectomy, herniorrhaphy and TURP (transurethral prostatectomy) procedures. Those rates were then compared to determine the relative risk of study surgery among A/D patients as compared to their non-A/D counterparts. The analyses accounted for the associations of age with both A/D and surgical procedures by stratifying patients in to the following three age groups: 67 to 69, 70 to 72 and 73 to 75. POPULATION STUDIED: The study population consisted of all non-Hispanic white male Medicare beneficiaries between the ages of 67 and 75 that were hospitalized in 1992 and were assumed free from a diagnosis of A/D up until that point. The study population included 16,023 A/D patients and 816,951 non-A/D patients. PRINCIPAL FINDINGS: When compared to non-A/D patients, those with A/D were less likely to undergo any of the study procedures over the six years of follow-up. However, A/D patients were much less likely to undergo a prostatectomy than a cholecystectomy, herniorrhaphy or TURP. The relative risks for a prostatectomy procedure among A/D patients ranged from 0.12 to 0.14, while those for the other three procedures ranged from 0.36 to 0.84. In an additional comparison of the rates of hospitalization for prostate cancer between the two cohorts, the relative risks ranged from 0.45 to 0.63. CONCLUSIONS: Assuming that the need for these procedures is comparable in A/D and non-A/D patients, it appears that patients hospitalized with A/D are significantly less likely to undergo the more invasive procedures for the treatment of the study conditions. Relative to prostatectomy, the findings suggest the presence of a treatment bias. Although A/D patients are as likely to be hospitalized with prostate cancer as they are for any of the other study conditions, they are significantly less likely to undergo a prostatectomy as part of the treatment for their prostate cancer. Further research is needed to investigate potential biases in the decisions for treatments of other conditions among patients with A/D and other cognitive impairments. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Cognitive impairment and dementia constitute a potential cause of treatment bias, leading to significant disparities in patient care. Additional research is warranted to determine whether such disparities in treatment are observed consistently across other medical and surgical conditions, and to assess their magnitude, when present.
Publication Types:
Keywords:
- Alzheimer Disease
- Biomedical Research
- Carcinoma
- Dementia
- Erectile Dysfunction
- European Continental Ancestry Group
- Humans
- Male
- Medicare
- Mental Disorders
- Prostatectomy
- Prostatic Neoplasms
- Sensitivity and Specificity
- Transurethral Resection of Prostate
- economics
- surgery
- hsrmtgs
UI: 103623531
From Meeting Abstracts