Can annual wellness visits reduce disparity in early dementia diagnosis?

Abstract

Introduction: Disparity exists in early dementia diagnoses by race/ethnicity, sex, education, and rural/urban residence. No data exist on whether Medicare Annual Wellness Visits (AWVs) can reduce these disparities.

Methods: Nested case-control studies included 100% Medicare beneficiaries with a new diagnosis of mild cognitive impairment (MCI) or Alzheimer's disease and related dementias (ADRD) in 2017 to 2020. We examined the association between AWV receipt and MCI diagnosis versus ADRD.

Results: Medicare beneficiaries who received an AWV were 13% to 21% more likely than those without an AWV to be diagnosed at MCI stage versus ADRD stage. The interaction effect of AWV, sex, and race/ethnicity on MCI diagnosis was significant. The likelihood of MCI diagnosis versus ADRD was similar between females and males among those who received AWVs. Receiving an AWV reduced, but did not eliminate, racial/ethnic differences in MCI diagnosis.

Discussion: AWVs had modest but significant effects in reducing disparity in the diagnosis of early cognitive impairment.

Highlights: Data from analyses of Medicare beneficiaries newly diagnosed with mild cognitive impairment/Alzheimer's disease and related dementias suggested a positive association between Annual Wellness Visit (AWV) use and early diagnosis of cognitive impairment (CI).AWVs had modest but significant effects in reducing the sex and racial/ethnic disparity in early CI diagnosis.Further studies, including on cognition assessment, caregivers' preferences for AWVs, and the ways in which providers deliver AWVs, will help us better understand the effect of AWVs on reducing disparities in early dementia diagnosis.