Challenges in identifying Latinos living with ADRD among newly diagnosed cancer patients
Melody Schiaffino, Alison A. Moore, Paul E Gilbert, James D Murphy, María J. Marquine- Psychiatry and Mental health
- Cellular and Molecular Neuroscience
- Geriatrics and Gerontology
- Neurology (clinical)
- Developmental Neuroscience
- Health Policy
- Epidemiology
Abstract
Background
Navigating the complex decision‐making and coordination challenges of a cancer diagnosis is difficult for any person diagnosed with cancer. This burden can become untenable for Latinos living with Alzheimer’s and Related Dementias (ADRD). The literature has demonstrated the disproportionate burden of late‐life comorbidities on Latino populations due to a myriad of existing inequities, such as barriers related to patient‐provider communication and language, cultural and other unique needs, and social and economic factors. Identifying ADRD and social correlates of risk for ADRD and cancer in Latino patients is critical to improve treatment planning and outcomes. However, Latinos are critically underrepresented in most population‐based and nationally‐representative databases. We studied a linked claims database and tumor registry to explore variation across tumor prevalence and social correlates of Latinos living with ADRD and cancer.
Methods
This retrospective cohort study examined ADRD and cancer in Latinos using the National Cancer Institute’s SEER‐Medicare database of newly diagnosed cancer patients aged 67+ (N = 337,932). Tumor and claims‐based utilization on Latino and non‐Latino patients with and without ADRD were used to explore variation in prevalence of ADRD, cancer, and social correlates. A non‐cancer 5% sample from the same Medicare cohort was used as a control.
Results
Latinos were widely underrepresented across all tumor sites: breast, cervical, colorectal, oral, lung, and prostate. The prevalence of Latino patients with ADRD and cancer varied significantly compared to White patients. Latinos had a higher prevalence across all cancer sites with the lowest prevalence for Latinos in Prostate cancer (4.63% vs 2.33% for White patients) and the highest in Oral cancer (12.67% vs 7.82%).
Conclusion
The differential prevalence of ADRD and cancer is significant in massive claims data which is a key source of nationally representative healthcare utilization and care information on older adults. Our cohort excluded dual‐eligible, metastatic, and undocumented patients. Claims and registry data lack context on language proficiency and diagnostic accuracy suggesting our substantial variation may be conservative. Improving methods and data for identifying and addressing social correlates of risk for patients with ADRD and cancer is critical for this rapidly growing and high‐risk population.