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Inequalities in access to and use of treatment

Diagnosis, assessment and treatment.


Inequalities in access to and use of treatment by people from minority ethnic groups

The whole issue of timely and accurate diagnosis is closely linked to gaining access to appropriate care and support, not only in the form of services (which is addressed in the next section), but also in the form of anti-dementia drugs. A study involving patients who were registered on the Norwegian national registry for primary health care reported differences in the proportion of native Norwegians or immigrants receiving treatment for dementia (Diaz, Kuman and Engedal 2015). A smaller proportion of immigrants, especially from low income countries, had received a diagnosis of memory impairment or dementia, and significantly more immigrants were diagnosed with memory impairment as opposed to dementia. According to the researchers, this may have been partly due to challenges diagnosing people from minority ethnic groups and the lack of culturally appropriate services.  Amongst patients who had received a diagnosis, a significantly lower proportion of the immigrants from the low income countries had purchased anti-dementia medication.  Having had an interpreter was associated with immigrants purchasing anti-dementia drugs, whereas the opposite was the case with regard to having consulted a GP with an immigrant background (although it is difficult to draw conclusions regarding GPs due to the small number available).

Another study by Stevnsborg et al. (2016), also based on a national registry, looked at the use of anti-dementia drugs amongst people born in Denmark, Western immigrants and non-Western immigrants.  They also found that a lower proportion of immigrants had received anti-dementia drugs (25-30% less compared to the people born in Denmark). The non-Western immigrants had the lowest use of anti-dementia drugs.

Stevnsborg and colleagues (2016) suggest the following possible explanations for the lower anti-dementia drug use described above:

  • Anti-dementia drugs are licenced for the treatment of Alzheimer’s dementia, as well as for dementia due to Parkinson’s disease and Lewy body dementia. There is some evidence that some minority ethnic groups have higher rates of vascular risk factors and vascular dementia.    
  • People from minority ethnic groups are often diagnosed at a later stage of dementia (most of the anti-dementia drugs are most effective in the earlier to middle stages).
  • Lower standards of diagnosis experienced by some people from minority ethnic groups result in higher rates of unspecified dementia. This may result in doctors not prescribing anti-dementia drugs.
  • The cost of anti-dementia drugs is mainly covered by the state (in Denmark and perhaps in many other countries in Europe). Many people from minority ethnic groups have limited financial resources so even a small cost may be a barrier for purchasing anti-dementia drugs.
  • Language barriers make it difficult to navigate the healthcare system.
  • The belief that dementia is a normal part of ageing may result in lower levels of use of anti-dementia drugs.

Possible explanations for the disparities in the use of anti-dementia drugs by different ethnic groups suggest a lack of equity, which in many cases may be linked to structural discrimination.


Key points

  • Timely and accurate diagnosis should contribute towards people from minority ethnic groups being offered the same standards of care, support and treatment as that offered to people from majority ethnic groups.  
  • Recent studies in Norway and Denmark found that people from minority ethnic groups were not being prescribed anti-dementia drugs on an equal basis as people from majority ethnic groups.
  • The non-Western immigrants in the Danish study and those from the low-income countries in the Norwegian study had the lowest use of anti-dementia drugs.
  • For people from minority ethnic groups with limited financial resources even a small cost may be a barrier for purchasing anti-dementia drugs.
  • Possible explanations for the lower anti-dementia drug use include people from minority ethnic groups not having been diagnosed with a specific form of dementia and/or a form that is suited to anti-dementia drug treatment, being diagnosed at a later stage, not having had an interpreter, being deterred by costs (however small they might be), finding it difficult to navigate the healthcare system and perceiving dementia as natural and hence, not requiring treatment.

Recommendations

  • Measures should be taken to improve the quality of diagnosis of people from minority ethnic groups so that they receive a diagnosis of a specific form of dementia (e.g. dementia due to Alzheimer’s disease, vascular dementia or Lewy Body dementia).
  • Healthcare professionals responsible for diagnosing dementia should have training in cultural awareness and to develop the cultural competence needed to ensure timely, accurate and differential diagnoses of dementia amongst members of minority ethnic groups.
  • The role of interpreters in the diagnostic procedure and reasons for low uptake of anti-dementia drugs should be further explored.

 

 
 

Last Updated: Monday 08 April 2019

 

 
  • Acknowledgements

    This report received funding under an operating grant from the European Union’s Health Programme (2014-2020) and from the Robert Bosch Stiftung. The content of the report represents the views of the author only and is his/her sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the Consumers, Health, Agriculture and Food Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains
  • European Union
 
 

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