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

A new study 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 led by Dr. Claire Godard-Sebillotte, a Professor in McGill University’s Division of Geriatrics and a researcher at the Research Institute of the McGill University Health Centre. 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.  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’re 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.

“The persistence of these patterns over nearly two decades of data is concerning," she said. "Access to care needs to be adapted to people’s needs. Equity isn’t about treating everyone the same, it’s 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.

“This 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’s 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,” she said.

Using data to drive change

As one of the directors of the Research on Organization of Healthcare Services for Alzheimer’s team, Godard-Sebillotte and her colleagues work closely with Quebec’s health minister to share their findings and support evidence-based decision-making.

The study’s insights informed the Quebec Policy on Alzheimer's Disease and Other Neurocognitive Disorders 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’s access to care.

About the study

“Examining equity in service use across socioeconomic status in people with dementia” by Claire Godard-Sebillotte and Isabelle Vedel et al., was published in Alzheimer’s & Dementia: Behavior & Socioeconomics of Aging.

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