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Survival differences in ethnic minorities with dementia: A systematic review and meta‐analysis
Author(s) -
Co Melissa,
Couch Elyse,
Gao Qian,
Martinez Andrea,
DasMunshi Jayati,
Prina Matthew
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.042733
Subject(s) - ethnic group , psycinfo , dementia , meta analysis , observational study , medicine , demography , population , medline , gerontology , systematic review , disease , environmental health , sociology , anthropology , political science , law
Background In the US and UK, some minority ethnic (ME) groups are thought to be at higher risk for developing dementia while simultaneously accessing care less frequently. Despite this, studies from both countries have suggested that ME groups may actually survive longer after a dementia diagnosis. We conducted a systematic review and meta‐analysis to investigate survival differences in dementia between ethnic groups in the literature. Method We searched Embase, Global Health, Ovid MEDLINE, and PsycINFO from inception to November 2018 for longitudinal observational studies which quantified racial/ethnic differences in mortality in dementia. Studies were included if they used ethnicity or race as a predictor for all‐cause mortality and reported a comparison between multiple ethnic groups, regardless of whether this was the primary aim. Records were screened for inclusion in double. Study quality was assessed using the Newcastle‐Ottawa Scale. Narrative synthesis was used to analyze and report findings of all eligible studies. A subset of studies from the US was included in a random‐effects meta‐analysis with robust variance estimation. Result We identified 21 eligible articles: 17 from the US, three from the UK, and one from the Netherlands. Across countries, all studies but one found lower or no difference in survival in ME groups as compared to the reference population. In the US, five out of 12 studies reported lower mortality in African American/Black ethnic groups and seven out of nine reported lower mortality in Hispanic/Latino groups as compared to non‐Hispanic White groups. From the meta‐analysis (six studies; n=101,502), the pooled hazard ratio (HR) for all ME subgroups compared to reference was 0.77 (99% c.i. 0.48‐1.24), although heterogeneity was high. Separate meta‐analyses of Black/African American and Hispanic/Latino groups found lower hazard of mortality in both (Black/African American: HR=0.86, 95% c.i. 0.82‐0.91, I 2 = 17%; Hispanic/Latino: HR=0.65, 95% c.i. 0.50‐0.84, I 2 = 86%). Overall, study quality was mixed, and studies rarely reported how ethnicity was ascertained or defined. Conclusion Available literature indicates that ME groups, particularly Hispanic American and African American groups, may have lower risk of mortality in dementia. Lack of consistency in reporting ethnicity is an issue in the literature.