There is a large amount of healthcare data available in the UK, and new statistical techniques are allowing researchers to analyse differences in dementia care between ethnic groups in detail for the first time. Professor Claudia Cooper used this data to identify inequalities in access to dementia diagnosis and prescription of different drugs in Black, Asian and White groups.
The Dunhill Medical Trust’s funding enabled us to gather evidence to start a conversation about structural inequalities in dementia healthcare and how we might start addressing themProfessor Claudia Cooper
I have a strong interest in uncovering structural inequalities in access to healthcare, particularly related to dementia – we can only address these issues if we know that they exist and identify where best to target interventions to ensure better care for all.
I wanted to see if there are differences in dementia diagnosis rates and prescriptions for dementia drugs and other treatments such as antipsychotics between people from Black, Asian and White backgrounds.
The first paper that we published from the project looked at the rates of dementia diagnosis in different ethnic groups, while the second focused on dementia and antipsychotic drug prescriptions. There has been a lot of work done to reduce the prescription of antipsychotic medications to people with dementia unless really necessary, so it was important to see if rates varied across these different groups.
Although we have data suggesting that people from Black backgrounds are more likely to be living with dementia compared with White people, they were less likely to receive a diagnosis for their condition. Black people were also prescribed antipsychotic medications for longer than White people.
People from Asian groups had much lower rates of diagnosis than White groups. However, there is less data available about how prevalent dementia is in Asian people as a baseline, so it’s harder to know if this is a result of structural inequalities or if something else is affecting rates. Additionally, people from Asian backgrounds were less likely to be prescribed anti-dementia drugs and were prescribed them for a shorter length of time.
Not only was I surprised at the extent of underdiagnosis in Black groups, I was concerned to see the differences in prescribing patterns, which suggests that medical guidelines are not being equally applied to all.
We can only address structural inequalities if we know that they exist and identify where best to target interventions to ensure better care for allProfessor Claudia Cooper
Our findings could indicate that we are failing certain groups in the population. If care is inequitable, we need to ask why: are services culturally competent? Are there any unconscious biases at work that are leading to inequitable care?
The Dunhill Medical Trust’s support
Before we started this project, there was no national data in the UK on dementia diagnosis and treatment for different ethnic groups. The Dunhill Medical Trust’s funding enabled us to gather evidence for big datasets, to start a conversation about structural inequalities in dementia healthcare and how we might start addressing them.
It’s difficult to get your first funding as a principal investigator (PI), but the DMT has been a great funder to work with. Their support helped me to start my career in research, with my first two PI grants in 2013 and 2017, and I’m very grateful for their support that enabled this research.
Find out more
You can read our first paper, investigating the rates of dementia diagnosis in different ethnic groups, at this link.
Our second paper, looking at ethnic differences in the prescribing of antipsychotic drugs for people with dementia, is available here.