Socio-Economic Disparities in Dementia Care in Quebec

A recent comprehensive study highlights significant disparities in dementia care across socioeconomic lines in Quebec, despite the province's universal healthcare system. Led by Dr. Claire Godard-Sebillotte from McGill University, the research is the first large-scale investigation into how social determinants influence dementia treatment outcomes in the region.

The study examined health records of approximately 200,000 individuals diagnosed with dementia between 2000 and 2017. Patients were monitored for a year or until death or institutionalization. To assess socioeconomic status, the researchers utilized a material deprivation index that evaluates neighborhoods based on income, education levels, and employment rates.

Findings revealed that residents in impoverished neighborhoods were substantially more prone to hospitalization, emergency room visits, and were more likely to be prescribed potentially inappropriate medications such as antipsychotics or benzodiazepines. These medications not only pose risks like falls and confusion but also indicate possible inequalities in care. Conversely, individuals from wealthier areas had increased access to specialized cognitive healthcare and regular consultations with dementia specialists.

The persistence of these healthcare disparities over nearly two decades raises questions about equity in Quebec’s healthcare system. Dr. Godard-Sebillotte emphasizes that equity does not mean uniform treatment but tailoring care to individual needs.

The study suggests that those in poorer areas may be in worse overall health by the time of diagnosis, reducing their ability to benefit from healthcare services. Limited access to home support services and caregiver assistance might contribute to a reliance on medications as a management strategy.

These findings have prompted policy discussions, with researchers collaborating with Quebec’s health authorities to address disparities. The Quebec Policy on Alzheimer’s Disease aims to reduce inequities in dementia care, an approach that is notably proactive compared to international standards.

Looking ahead, the research team plans to explore how factors such as racialization, language barriers, and rural residence intersect with poverty to further impact healthcare access and outcomes.

Understanding and addressing these socioeconomic barriers is critical to ensuring equitable dementia care for all populations in Quebec.