Access disparities to dementia pharmacological treatment among natives and migrants in Lazio, Italy

Abstract Background Previous studies showed that migrants receive lower-quality dementia diagnoses, but evidence on treatment access and adherence is limited. Our study aimed to investigate whether inequalities exist in access to antidementia and antipsychotic treatment between migrants and native Italians with dementia. Methods An observational study was conducted on individuals ≥50 in Lazio, registered with the Regional Health Service as of Dec 31, 2022. Dementia patients were identified using a validated algorithm from Health Information Systems. Migrant status was classified by country of birth: native Italians, High Migratory Pressure Countries (HMPC), or Highly Developed Countries (HDC). Comorbidities and use of anti-dementia/antipsychotic drugs (≥2 prescriptions) were assessed in the 2 years prior. Multivariable logistic regression estimated the association between migrant status and medication use, with results as odds ratios (ORs) and 95% confidence intervals (CIs). Results As of Dec 31, 2022, 37,583 people with dementia lived in Lazio; 2.7% were from HMPCs, 1.1% from HDCs. Natives and HDCs were older than HMPCs; migrants had a higher proportion of females. Anti-dementia drug use was higher in natives (55.5%) than HDCs (51.7%) and HMPCs (48.3%, p < 0.0001), with lowest use among Asians (29.8-44.4%). After adjusting for sex and age, HMPC origin was associated with lower odds of antidementia treatment vs natives (OR: 0.81; 95% CI: 0.71-0.92). No significant difference was found for HDCs (OR: 0.91; 95% CI: 0.74-1.12). No differences were found in antipsychotics use. Conclusions This study found lower antidementia drug use among migrants, especially those from HMPCs, vs native Italians. Despite lacking data on dementia severity, results suggest possible undertreatment in migrants. This issue warrants attention from policymakers and healthcare providers to support the delivery of accessible and effective dementia care across all population groups. Key messages • The potential undertreatment of dementia in Italy’s migrant population raises concerns about healthcare equity. • Policymakers and healthcare providers must address these inequalities to ensure equitable dementia care.