Study links dementia care gaps in Quebec to socio-economic status

A has found stark differences in the dementia care received by people in richer and poorer neighbourhoods in Quebec, despite the universal health-care system.

The research was co-led by Dr. Claire Godard-Sebillotte, a Professor in 黑料不打烊 University鈥檚 Division of Geriatrics and a researcher at the Research Institute of the 黑料不打烊 University Health Centre, and聽Dr. Isabelle Vedel, a Professor in 黑料不打烊's Department of Family Medicine,聽in collaboration with the Institut national de sant茅 publique du Qu茅bec.

It is the first large-scale study in Quebec to track how social conditions relate to dementia care.

The study analyzed health records from about 200,000 people newly diagnosed with dementia between 2000 and 2017. Each patient was followed for a year or until their death or admission to a long-term care facility, whichever occurred first.鈥� To measure socio-economic status, the researchers used a standard material deprivation index, which ranks neighbourhoods based on income, education and employment levels.

People in the most deprived areas were more likely than people in the least deprived areas to be hospitalized, visit the emergency room, receive potentially inappropriate medications and die within a year of diagnosis. Meanwhile, people in wealthier neighbourhoods had more visits to cognition specialists.

Health-care disparities in context

Due to lifelong disadvantages, people in poorer areas may be in worse health by the time they鈥檙e diagnosed with dementia, which could partly explain why they rely more on hospitals and die more within the year of diagnosis. However, this raises questions about equity within our universal healthcare system, said Godard-Sebillotte.

鈥淭he persistence of these patterns over nearly two decades of data is concerning," she said. "Access to care needs to be adapted to people鈥檚 needs. Equity isn鈥檛 about treating everyone the same, it鈥檚 about making sure each person gets the right care for their situation."

People in poorer neighborhoods were more likely to be prescribed medications such as antipsychotics or benzodiazepines, which can increase the risk of falls and confusion. They were also less likely to see cognition specialists.

鈥淭his result suggests inequity. Indeed, if people in poorer neighborhoods consistently had more complex health needs, requiring these potentially inappropriate medications, they should be referred more to cognition specialists. It鈥檚 possible that people in these areas are actually not more complex but have less access to home care or other supports for caregivers to help manage difficult behaviours or symptoms, so doctors may turn to medications more often,鈥� she said.

Using data to drive change

As directors of the Research on Organization of Healthcare Services for Alzheimer鈥檚 (ROSA)聽team, Vedel, Godard-Sebillotte and their colleagues work closely with Quebec鈥檚 health minister to share their findings and support evidence-based decision-making.

The study鈥檚 insights informed the first聽 which, contrary to most policies internationally, includes a standalone objective to reduce inequities in dementia care.

Next, the research team plans to examine how racialization, language and living in rural areas intersect with poverty to shape people鈥檚 access to care.

About the study

鈥溾�� by Claire Godard-Sebillotte, Genevi猫ve Arsenault-Lapierre, Nadia Sourial, Sanjna Navani, Am茅lie Quesnel-Vall茅e, Louis Rochette, Victoria Massamba and Isabelle Vedel was published in Alzheimer鈥檚 & Dementia.

This study was supported by the Canadian Consortium on Neurodegeneration in Aging.