Healthcare Expenditures Among Older Immigrants in the United States With Alzheimer's Disease and Related Dementias: Population-Based Study Between 2007 and 2020

Objectives: Using nationally representative data sets, this study examined differences in healthcare expenditures between U.S.-born and foreign-born individuals aged 65 and above by the presence of Alzheimer's disease and related dementias (ADRD) and cognitive limitations (CL). This study further examined whether healthcare expenditures among foreign-born individuals vary by their duration of residence in the United States.

Methods: The study used the 2007-2020 Medical Expenditure Panel Survey and employed generalized linear regression models to estimate differences in healthcare expenditures between U.S.-born and foreign-born older adults with ADRD, CL, and without ADRD or CL. Survey weights were applied to all estimates.

Results: Our study identified significant differences in healthcare expenditures among older adults by the presence of ADRD/CL and immigrant status. Having ADRD/CL had a more pronounced impact on high healthcare expenditures among foreign-born older adults than U.S.-born adults with ADRD/CL, thereby diminishing the difference in healthcare expenditures by U.S. nativity status for the older adults with ADRD or CL. In the analysis further distinguishing immigrants by their duration of residence, lower healthcare expenditures were primarily observed among foreign-born individuals with ADRD or CL who had lived in the United States for less than 10 years.

Discussion: Our results suggest potential shifts in costs resulting from delayed access to, and diagnosis or treatment of ADRD at a younger age, leading to increased healthcare needs and expenses among U.S. foreign-born older adults.