A groundbreaking new study has revealed striking disparities in the quality and type of dementia care received by individuals residing in wealthier versus poorer neighborhoods within Quebec, despite the province’s universal healthcare system. This comprehensive research exposes the socio-economic inequities that persist in dementia treatment, raising serious questions about the effectiveness and fairness of healthcare delivery models that are presumed to guarantee equal access for all.
The study was spearheaded by Dr. Claire Godard-Sebillotte, a respected professor at McGill University’s Division of Geriatrics and a researcher affiliated with the Research Institute of the McGill University Health Centre. Her work represents the first extensive examination in Quebec of how social determinants of health, specifically socio-economic status, influence patterns of dementia care over time. By utilizing a robust dataset comprising nearly 200,000 newly diagnosed dementia patients spanning the years 2000 to 2017, the research provides a meticulous longitudinal analysis that explores both health outcomes and care utilization.
To quantify socio-economic status, the team employed a standardized material deprivation index, which evaluates neighborhoods based on key indicators such as income, educational attainment, and employment rates. Patients were followed for a year after their diagnosis, or until death or institutionalization in long-term care facilities if these events occurred earlier. This careful methodological design enabled the researchers to draw nuanced connections between deprivation levels and variables like hospitalization rates, emergency room visits, prescription practices, specialist consultations, and mortality.
Findings starkly highlighted that individuals from the most deprived areas were more frequently hospitalized and more likely to visit emergency departments than their counterparts from affluent neighborhoods. Equally concerning was the increased prescription of potentially inappropriate medications such as antipsychotics and benzodiazepines in these socio-economically disadvantaged groups. These drugs, often linked with adverse side effects—including falls, cognitive impairment, and increased confusion—point toward suboptimal clinical management in deprived regions.
In stark contrast, dementia patients living in wealthier areas experienced greater access to cognitive specialists, suggesting a more intensive and perhaps more appropriate level of follow-up and therapeutic intervention. This imbalance suggests systemic barriers in accessing specialist care among poorer populations, leaving a gap in care quality that threatens equitable health outcomes.
Dr. Godard-Sebillotte emphasized that lifetime socio-economic disadvantages likely culminate in worse baseline health among people in impoverished neighborhoods by the time dementia is diagnosed. This phenomenon may partially explain their increased reliance on hospitals and higher mortality rates within the first year following diagnosis. However, she underscored that these patterns persisted consistently across almost two decades, indicating entrenched structural inequities rather than isolated incidents.
Importantly, the research challenges the notion that equity entails uniform treatment for all patients. Instead, it advocates for a model of care customized to individual needs, recognizing that equal access is not synonymous with equitable outcomes. Such a perspective calls for reallocating resources and adapting services to address the unique challenges faced by marginalized populations, particularly in the context of complex chronic diseases like dementia.
Another crucial insight from the study was the apparent preference for pharmacological management—potentially inappropriate medications—in deprived neighborhoods, possibly reflecting insufficient access to alternative support systems such as home care or caregiver resources. The limited engagement with cognitive specialists in these areas may exacerbate this issue, as specialist consultations often provide non-pharmacological strategies to manage behavioral and psychological symptoms of dementia.
This research underscores the pressing need to transform approaches to dementia care by integrating social determinants of health into clinical decision-making and health policy planning. As a direct result of their findings, Dr. Godard-Sebillotte and her team have collaborated closely with Quebec’s health ministry, influencing policy development that explicitly addresses inequities in dementia care—a rare and commendable inclusion in national and provincial health strategies.
The Quebec Policy on Alzheimer’s Disease and Other Neurocognitive Disorders now features a dedicated objective to reduce disparities in dementia service provision. This policy innovation sets a precedent internationally, highlighting Quebec’s commitment to ensuring that universal health coverage translates not merely to equal access, but to fair and just health outcomes for all citizens, regardless of socio-economic background.
Looking ahead, the research group intends to expand their investigations to assess how the intersectionality of race, language, and rural residency further interacts with poverty to influence dementia care accessibility. This anticipated work promises to deepen our understanding of the complex socio-demographic factors that shape healthcare experiences and outcomes for vulnerable populations.
In sum, this landmark study offers compelling evidence that social inequities permeate healthcare systems, even in settings with universal coverage. It calls on clinicians, policymakers, and health systems to actively recognize and address these disparities through informed, data-driven strategies that prioritize equitable care delivery for people living with dementia.
Subject of Research: People
Article Title: Examining equity in service use across socioeconomic status in people with dementia
News Publication Date: 19-Feb-2025
Web References:
- https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/bsa3.70006
- https://www.mcgill.ca/expmed/dr-claire-godard-sebillotte
- https://www.mcgill.ca/familymed/research/projects/research-organization-healthcare-services-alzheimers-rosa
- https://publications.msss.gouv.qc.ca/msss/document-003867/
References:
Godard-Sebillotte, C., Vedel, I., et al. (2025). Examining equity in service use across socioeconomic status in people with dementia. Alzheimer’s & Dementia: Behavior & Socioeconomics of Aging. DOI: 10.1002/bsa3.70006
Keywords: Dementia, Social sciences, Psychological science, Clinical psychology, Cognitive disorders