Racial/Ethnic Disparities in Emergency Department Visits Among Alzheimer's Patients with Comorbid Hypertension and Type 2 Diabetes in Ambulatory Care in 2021

Abstract

Background: Alzheimer's disease (AD) is a prevalent neurodegenerative disorder, especially challenging when patients have comorbid conditions such as hypertension (HTN) and type 2 diabetes (T2D). These conditions exacerbate healthcare challenges and lead to frequent emergency department (ED) visits, particularly among racial and ethnic minority populations. This study aims to investigate racial/ethnic disparities in ED visits among Alzheimer's patients with comorbid HTN and T2D in ambulatory care settings during 2021.Methods: This cross-sectional study utilized data from the 2021 National Hospital Ambulatory Medical Care Survey (NHAMCS), focusing on ED visits by Alzheimer's patients with comorbid HTN and T2D. The study examined the association between race/ethnicity and ED visit outcomes, including length of stay (LOS) and inpatient mortality. Key variables included patient demographics, comorbid conditions, and ED visit characteristics. Multivariate logistic regression and decision tree analysis were employed to identify significant predictors of ED outcomes, adjusting for potential confounders. Results: The study analyzed 16,207 ED visits, of which 1.28% involved Alzheimer's patients. Black and Hispanic patients exhibited higher odds of prolonged LOS (OR: 1.35, 95% CI: 1.20-1.52 for Black; OR: 1.28, 95% CI: 1.15-1.43 for Hispanic) and increased inpatient mortality (OR: 1.45, 95% CI: 1.25-1.67 for Black; OR: 1.32, 95% CI: 1.14-1.53 for Hispanic) compared to White patients. Decision tree analysis highlighted complex interactions, identifying older Black and Hispanic patients with both HTN and T2D as the highest-risk group for adverse outcomes. Conclusion: Significant racial and ethnic disparities in ED visits and outcomes were observed among Alzheimer's patients with comorbid HTN and T2D. The findings underscore the urgent need for targeted interventions and policies to address these inequities. Culturally tailored healthcare strategies and integrated care models are essential to improve health outcomes and achieve health equity for minority populations with chronic conditions. This study emphasizes the importance of a holistic approach to mitigate the adverse effects of systemic barriers on vulnerable populations.