Sex/Gender, Relationship Status, and Alzheimer’s and Related Dementia Diagnoses after Probable Dementia

Abstract Background Differences by relationship status have been found in both cognitive‐assessment scores and prevalence and incidence rates for Alzheimer’s disease and related dementias (ADRD), but little is known about delayed and missed ADRD diagnoses after cognitive impairment emerges. Existing research has reported underdiagnosis for people of color, men, and people with less education. Method Using data from the Health and Retirement Study (2000‐2018), we analyzed associations between relationship status and time to ADRD diagnosis following probable dementia (PD). We examined risk of ADRD diagnosis by sex/gender and relationship status (married/partnered or single at the time of the first PD‐scoring assessment), adjusting for race/ethnicity, age, and education. Cox proportional hazards modeling was used to account for right‐censoring, with the risk period beginning at the time of the incident PD. Failure occurred when ADRD diagnosis was self‐reported. We also examined time until diagnosis among all participants with a recorded case of incident PD (N = 3,216 subjects: 9,540 observations). Restricted mean times to diagnosis and multivariable‐adjusted hazard ratios (aHR) with 95% Confidence Intervals (95% C.I.) were reported. Result Table 1 shows summary statistics; Table 2 provides hazard ratios; Table 3 shows mean times to diagnosis. Married/partnered women had the highest likelihood of receiving a diagnosis during the study period (HR: 1.197; 95% CI: 1.020‐1.360; p = <.001); single woman also had higher risk of diagnosis (HR: 1.178; 95% CI: 1.025–1.400; p = <.001). Mean time to diagnosis for men was 8.69 (±0.20); for women, 7.38 (±0.13). Singles received diagnoses sooner (7.32±0.135 years) than married/partnered people (8.39±0.169). Categorizing by sex/gender and relationship status, married/partnered women have the lowest mean times (7.00±0.148); single and married/partnered men’s mean times to diagnosis do not differ. Conclusion Relationship status is associated with women’s likelihood of reporting ADRD diagnosis and time to diagnosis, but not men’s. Further investigation is required to analyze potential sources of this disparity, including interactions with education, income, and insurance status, and additional gendered relationship, social, and familial factors.