{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T10:39:35Z","timestamp":1786358375771,"version":"build-2736575974"},"reference-count":28,"publisher":"SAGE Publications","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAD"],"published-print":{"date-parts":[[2023,11,7]]},"abstract":"<jats:p>Background: Despite the high burden of Alzheimer\u2019s disease and other dementias among the Hispanic population worldwide, little is known about how dementia affects healthcare utilizations among this population outside of the US, in particular among those in the Caribbean region. Objective: This study examines healthcare utilization associated with Alzheimer\u2019s disease and other dementias among older adults in the Caribbean as compared to the US. Methods: We conducted harmonized analyses of two population-based surveys, the 10\/66 Dementia Group Research data collected in Dominican Republic, Cuba, and Puerto Rico, and the US-based Health and Retirement Study. We examined changes in hospital nights and physician visits in response to incident and ongoing dementias. Results: Incident dementia significantly increased the risk of hospitalization and number of hospital nights in both populations. Ongoing dementia increased the risk of hospitalization and hospital nights in the US, with imprecise estimates for the Caribbean. The number of physician visits was elevated in the US but not in the Caribbean. Conclusions: The concentration of increased healthcare utilization on hospital care and among patients with incident dementia suggests an opportunity for improved outpatient management of new and existing dementia patients in the Caribbean.<\/jats:p>","DOI":"10.3233\/jad-230505","type":"journal-article","created":{"date-parts":[[2023,10,13]],"date-time":"2023-10-13T12:15:49Z","timestamp":1697199349000},"page":"801-811","source":"Crossref","is-referenced-by-count":1,"title":["Dementia Attributable Healthcare Utilizations in the Caribbean versus United States"],"prefix":"10.1177","volume":"96","author":[{"given":"Jing","family":"Li","sequence":"first","affiliation":[{"name":"The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan","family":"Weiss","sequence":"additional","affiliation":[{"name":"Stanford Center on Longevity, Stanford University, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish","family":"Rajadhyaksha","sequence":"additional","affiliation":[{"name":"New York-Presbyterian Hospital, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisy","family":"Acosta","sequence":"additional","affiliation":[{"name":"Universidad Nacional Pedro Henriquez Ure\u00f1a (UNPHU), Santo Domingo, Dominican Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amal","family":"Harrati","sequence":"additional","affiliation":[{"name":"Mathematica Policy Research, Oakland, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivonne Z.","family":"Jim\u00e9nez Vel\u00e1zquez","sequence":"additional","affiliation":[{"name":"Department of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mao-Mei","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Demography, University of California at Berkeley, Berkeley, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge J. Llibre","family":"Guerra","sequence":"additional","affiliation":[{"name":"Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan de Jes\u00fas Llibre","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Medical University of Havana, Havana, Cuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William H.","family":"Dow","sequence":"additional","affiliation":[{"name":"Department of Demography, University of California at Berkeley, Berkeley, CA, USA"},{"name":"School of Public Health, University of California at Berkeley, Berkeley, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","reference":[{"key":"10.3233\/JAD-230505_ref2","doi-asserted-by":"crossref","first-page":"2560","DOI":"10.1002\/alz.12619","article-title":"Healthcare costs of dementia diseases before, during and after diagnosis: Longitudinal analysis of 17 years of Swedish register data","volume":"18","author":"Persson","year":"2022","journal-title":"Alzheimers Dement"},{"key":"10.3233\/JAD-230505_ref3","doi-asserted-by":"crossref","first-page":"185","DOI":"10.3233\/JAD-170518","article-title":"Economic burden, mortality, and institutionalization in patients newly diagnosed with Alzheimer\u2019s disease","volume":"61","author":"Black","year":"2018","journal-title":"J Alzheimers Dis"},{"key":"10.3233\/JAD-230505_ref4","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1377\/hlthaff.2013.1179","article-title":"Hospital and ED use among Medicare beneficiaries with dementia varies by setting and proximity to death","volume":"33","author":"Feng","year":"2014","journal-title":"Health Affairs"},{"key":"10.3233\/JAD-230505_ref5","doi-asserted-by":"crossref","DOI":"10.1177\/2333721416689042","article-title":"Health care utilization among elderly medicare beneficiaries with coexisting dementia and cancer","volume":"3","author":"Kedia","year":"2017","journal-title":"Gerontol Geriatr Med"},{"key":"10.3233\/JAD-230505_ref7","doi-asserted-by":"crossref","first-page":"e0227681","DOI":"10.1371\/journal.pone.0227681","article-title":"Healthcare utilization of Mexican-American Medicare beneficiaries with and without Alzheimer\u2019s disease and related dementias","volume":"15","author":"Downer","year":"2020","journal-title":"PLoS One"},{"key":"10.3233\/JAD-230505_ref8","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1177\/1533317512467679","article-title":"Health disparities in cost of care in patients with Alzheimer\u2019s disease: An analysis across 4 state Medicaid populations","volume":"28","author":"Gilligan","year":"2013","journal-title":"Am J Alzheimers Dis Other Demen"},{"key":"10.3233\/JAD-230505_ref12","first-page":"s168","article-title":"The health system of Cuba","volume":"53","author":"Dom\u00ednguez-Alonso","year":"2011","journal-title":"xico"},{"key":"10.3233\/JAD-230505_ref13","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1097\/MLR.0b013e3182408027","article-title":"Are there differences in the Medicare experiences of beneficiaries in Puerto Rico compared with those in the US mainland","volume":"50","author":"Elliott","year":"2012","journal-title":"Med Care"},{"key":"10.3233\/JAD-230505_ref14","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1001\/jamainternmed.2016.0267","article-title":"Quality of care for white and Hispanic Medicare Advantage enrollees in the United States and Puerto Rico","volume":"176","author":"Rivera-Hernandez","year":"2016","journal-title":"JAMA Intern Med"},{"key":"10.3233\/JAD-230505_ref15","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1001\/jama.2011.1964","article-title":"Association of incident dementia with hospitalizations","volume":"307","author":"Phelan","year":"2012","journal-title":"JAMA"},{"key":"10.3233\/JAD-230505_ref16","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1159\/000310350","article-title":"Utilization patterns of ambulatory medical care before and after the diagnosis of dementia in Germany\u2013results of a case-control study","volume":"29","author":"Eisele","year":"2010","journal-title":"Dement Geriatr Cogn Disord"},{"key":"10.3233\/JAD-230505_ref17","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1186\/1471-2458-7-165","article-title":"The protocols for the 10\/66 dementia research group population-based research programme","volume":"7","author":"Prince","year":"2007","journal-title":"BMC Public Health"},{"key":"10.3233\/JAD-230505_ref18","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1093\/ije\/dyu067","article-title":"Cohort profile: The Health and Retirement Study (HRS)","volume":"43","author":"Sonnega","year":"2014","journal-title":"Int J Epidemiol"},{"key":"10.3233\/JAD-230505_ref19","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/S0140-6736(03)12772-9","article-title":"Dementia diagnosis in developing countries: A cross-cultural validation study","volume":"361","author":"Prince","year":"2003","journal-title":"Lancet"},{"key":"10.3233\/JAD-230505_ref20","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1093\/gerona\/glab063","article-title":"Race, genetic admixture, and cognitive performance in the Cuban population","volume":"77","author":"Llibre-Guerra","year":"2022","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"10.3233\/JAD-230505_ref21","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/S0140-6736(12)60399-7","article-title":"Dementia incidence and mortality in middle-income countries, and associations with indicators of cognitive reserve: A 10\/66 Dementia Research Group population-based cohort study","volume":"380","author":"Prince","year":"2012","journal-title":"Lancet"},{"key":"10.3233\/JAD-230505_ref22","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1097\/EDE.0000000000000945","article-title":"Comparison of methods for algorithmic classification of dementia status in the health and retirement study","volume":"30","author":"Gianattasio","year":"2019","journal-title":"Epidemiology"},{"key":"10.3233\/JAD-230505_ref23","doi-asserted-by":"crossref","first-page":"i162","DOI":"10.1093\/geronb\/gbr048","article-title":"Assessment of cognition using surveys and neuropsychological assessment: The Health and Retirement Study and the Aging, Demographics, and Memory Study","volume":"66","author":"Crimmins","year":"2011","journal-title":"J Gerontol B Psychol Sci Soc Sci"},{"key":"10.3233\/JAD-230505_ref24","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1001\/jamainternmed.2016.6807","article-title":"A comparison of the prevalence of dementia in the United States in 2000 and 2012","volume":"177","author":"Langa","year":"2017","journal-title":"JAMA Intern Med"},{"key":"10.3233\/JAD-230505_ref25","doi-asserted-by":"crossref","first-page":"e12204","DOI":"10.1002\/trc2.12204","article-title":"Associations between education and dementia in the Caribbean and the United States: An international comparison","volume":"7","author":"Li","year":"2021","journal-title":"Alzheimers Dement (N Y)"},{"key":"10.3233\/JAD-230505_ref26","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1056\/NEJMsa1204629","article-title":"Monetary costs of dementia in the United States","volume":"368","author":"Hurd","year":"2013","journal-title":"N Engl J Med"},{"key":"10.3233\/JAD-230505_ref27","first-page":"16","article-title":"Cuban public healthcare: A model of success for developing nations","volume":"35","author":"Pineo","year":"2019","journal-title":"J Dev Soc"},{"key":"10.3233\/JAD-230505_ref28","doi-asserted-by":"crossref","first-page":"617","DOI":"10.3233\/JAD-150692","article-title":"Timely diagnosis for Alzheimer\u2019s disease: A literature review on benefits and challenges","volume":"49","author":"Dubois","year":"2016","journal-title":"J Alzheimers Dis"},{"key":"10.3233\/JAD-230505_ref30","doi-asserted-by":"crossref","first-page":"S328","DOI":"10.1093\/geronb\/63.5.S328","article-title":"Racial and ethnic disparities in the treatment of dementia among Medicare beneficiaries","volume":"63","author":"Zuckerman","year":"2008","journal-title":"J Gerontol B Psychol Sci Soc Sci"},{"key":"10.3233\/JAD-230505_ref31","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/WAD.0b013e318211c6c9","article-title":"Diversity and disparity in dementia: The impact of ethnoracial differences in Alzheimer\u2019s disease","volume":"25","author":"Chin","year":"2011","journal-title":"Alzheimer Dis Assoc Disord"},{"key":"10.3233\/JAD-230505_ref32","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1002\/gps.1037","article-title":"Knowledge of Alzheimer\u2019s disease in four ethnic groups of older adults","volume":"19","author":"Ayalon","year":"2004","journal-title":"Int J Geriatr Psychiatry"},{"key":"10.3233\/JAD-230505_ref33","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1080\/13557858.2017.1297776","article-title":"Gender and national origin differences in healthcare utilization among US Immigrants from Mexico, China, and India","volume":"23","author":"Read","year":"2018","journal-title":"Ethn Health"},{"key":"10.3233\/JAD-230505_ref34","first-page":"1","article-title":"Long-term care in Latin America and the Caribbean","volume":"20","author":"Bloeck","year":"2019","journal-title":"Economia"}],"container-title":["Journal of Alzheimer's Disease"],"original-title":[],"link":[{"URL":"https:\/\/content.iospress.com\/download?id=10.3233\/JAD-230505","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T10:08:41Z","timestamp":1777370921000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/full\/10.3233\/JAD-230505"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,7]]},"references-count":28,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3233\/jad-230505","relation":{},"ISSN":["1387-2877","1875-8908"],"issn-type":[{"value":"1387-2877","type":"print"},{"value":"1875-8908","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,7]]}}}