Ambulatory Care Sensitive Hospitalizations and Disparities Among Older Adults With Dementia Before and During the Pandemic.

Abstract

Background: Older adults with Alzheimer's disease and related dementias (ADRD) are frequently hospitalized with ambulatory care-sensitive conditions (ACSCs). Disparities in ACSC hospitalizations have been documented, but the impact of the COVID-19 pandemic on ACSC hospitalizations and disparities of older adults with ADRD is unclear, particularly, across different racial, ethnic, and socioeconomic groups. This study examined changes in ACSC hospitalizations among community-dwelling older adults with ADRD before and during the pandemic and how these changes vary by race, ethnicity, and Medicare-Medicaid dual eligibility status.

Methods: This observational study linked Medicare data with publicly available sources. The study sample included Medicare fee-for-service community-dwelling older adults aged 65 and older with ADRD in 2019 or 2021. The primary outcome was whether an individual had any ACSC hospitalizations in a given year (0/1). Secondary outcomes included any non-COVID-19-related hospitalizations and death (0/1). We used linear probability models with zip-code random effects, accounting for individual and community characteristics.

Results: The study included 2.35 million beneficiaries in 2019 and 1.85 million in 2021. Non-COVID-19-related hospitalizations decreased from 24.0% in 2019 to 20.4% in 2021, while ACSC hospitalizations fell from 23.0% to 19.0% among those who were hospitalized. In 2019, Black and Hispanic individuals had 2.0 and 1.6 percentage points higher probabilities of ACSC hospitalization (p < 0.001), respectively, compared to White individuals, and dual-eligibles had a 2.8 percentage-point higher probability than non-dual-eligibles (p < 0.001). During the pandemic, overall hospitalizations and ACSC hospitalizations decreased, with dual-eligibles experiencing an additional 2.1 percentage-point reduction in ACSC hospitalizations(p < 0.001). Meanwhile, dual-eligibles experienced a 1.5 percentage-point increase in mortality rate in 2021 compared to 2019 (p < 0.001).

Conclusion: Racial and ethnic minorities and the socioeconomically disadvantaged older adults with ADRD were more likely to experience ACSC hospitalizations compared to their counterparts before the pandemic.