The diagnosis of schizophrenia among nursing home residents with ADRD: Does race matter?

Abstract Objective To examine racial differences in the frequency of schizophrenia diagnosis codes used among nursing home (NH) residents with Alzheimer's Disease and Related Dementias (ADRD), pre and post the implementation of public reporting of antipsychotic use in NHs). Methods The 2011-2017 Minimum Data Set and Medicare Master Beneficiary Summary File were linked. We identified long-stay NH residents (i.e. those who had quarterly or annual assessments) with ADRD aged 55 years and older (N=7,734,348). Outcome variable was defined as the diagnosis of schizophrenia documented in the MDS assessments. Main variables of interest included individual race (Black versus White), the percent of Blacks in a NH and time trend. Multivariate regressions were estimated. Results The frequency of schizophrenia diagnosis codes among NH residents with ADRD steadily increased over the study period, and Blacks experienced a greater increase than their White counterparts. For example, the overall likelihood of having schizophrenia diagnosis increased 1.9 percentage points (95% confidence interval [CI]:[0.019, 0.020], P Conclusion Following the implementation of public reporting of antipsychotic use in NH, Black residents experienced a greater increase in the likelihood of having schizophrenia diagnosis than White NH residents. NHs with a higher proportion of Blacks had a greater increase in schizophrenia diagnosis, and Blacks experienced an increased likelihood of schizophrenia diagnosis than Whites within a NH. Further research is need to determine a causal relationship between the federal policy mandating public reporting and disparities in schizophrenia diagnostic coding.