Differences in survival and mortality in minority ethnic groups with dementia: A systematic review and meta‐analysis

Objectives: Although there are disparities in both risk of developing dementia and accessibility of dementia services for certain minority ethnic groups in the United States and United Kingdom, disparities in survival after a dementia diagnosis are less well‐studied. Our objective was to systematically review the literature to investigate racial/ethnic differences in survival and mortality in dementia. Methods: We searched Embase, Ovid MEDLINE, Global Health and PsycINFO from inception to November 2018 for studies comparing survival or mortality over time in at least two race/ethnicity groups. Studies from any country were included but analysed separately. We used narrative synthesis and random‐effects meta‐analysis to synthesise findings. The Newcastle–Ottawa Scale was used to assess quality and risk of bias in individual studies. Results: We identified 22 articles, most from the United States (n = 17), as well as the United Kingdom (n = 3) and the Netherlands (n = 1). In a meta‐analysis of US studies, hazard of mortality was lower in Black/African American groups (Pooled Hazard Ratio = 0.86, 95% CI = 0.82–0.91, I2 = 17%, from four studies) and Hispanic/Latino groups (Pooled HR = 0.65, 95% CI = 0.50–0.84, I2 = 86%, from four studies) versus comparison groups. However, study quality was mixed, and in particular, quality of reporting of race/ethnicity was inconsistent. Conclusion: Literature indicates that Black/African American and Hispanic/Latino groups may experience lower mortality in dementia versus comparison groups in the United States, but further research, using clearer and more and consistent reporting of race/ethnicity, is necessary to understand what drives these patterns and their implications for policy and practice. Key points: Despite evidence that some minority race/ethnicity groups are at higher risk of developing dementia and face barriers to accessing care, racial/ethnic differences in survival following a dementia diagnosis are not widely studied, particularly outside the United StatesIn the United States, Black/African American and Hispanic/Latino groups may have lower hazard of dying after dementia diagnosis versus comparison groups, similar to survival patterns in populations without dementiaHowever, studies do not always clearly describe how race/ethnicity is defined or ascertained, affecting interpretability of resultsFuture research should consider mechanisms driving survival differences and implications of longer survival, including financial and caregiving impacts on families