Educational Disparities in Dementia Incidence and Healthcare Utilization: Evidence from a Cohort Study in Italy

Agostino Cristofalo, Sapienza University of Rome
Silvia Cascini, Department of Epidemiology of the Lazio Region
Giulia Cesaroni, Department of Epidemiology of the Lazio Region
Eleonora Trappolini, Sapienza University of Rome
Nera Agabiti, Department of Epidemiology of the Lazio Region
Anna Maria Bargagli, Department of Epidemiology of the Lazio Region

Background: Disparities in dementia incidence are well-known; whether they persist beyond disease onset is less explored. We investigated educational disparities in the risk of dementia diagnosis in administrative records (dementia incidence) and subsequent healthcare utilization. Methods: We analysed the Lazio Region Longitudinal Study (Italy) from 2012 to 2022. Applying Cox proportional hazards regression, we explored educational disparities in dementia incidence among 50-90 years-old dementia-free individuals and in subsequent all-cause hospitalizations, potentially-preventable hospitalizations, and emergency visits. Results: We found strong educational disparities in dementia incidence. Compared to highly-educated, the hazard for low-educated men and women was more pronounced at ages 50-64, than at ages 65-89, and 90 and over. Low-educated men and women had a higher risk of all-cause hospitalizations, potentially-preventable hospitalizations, and emergency visits. Only disparities in emergency visits persisted after controlling for pre-existing health conditions. Conclusions: We found disparities in dementia incidence. Disparities persisted to a lesser extent in subsequent healthcare utilization and were mostly explained by differences in pre-existing health conditions.

Keywords: Health and Morbidity, Population Ageing, Inequality, Disadvantage and Discrimination, Human Capital, Education, and Work

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