Public Health.

Background: Despite the growing number and proportion of the immigrant population in the US, there is a lack of knowledge on healthcare expenditures among immigrants with cognitive limitations or Alzheimer's disease and related dementias (ADRD). This study estimated differences in total healthcare expenditures between US-born and foreign-born individuals by the presence of ADRD and/or cognitive limitations. This study also examined the differences in healthcare expenditures by service types, including inpatient stays, office-based visits, emergency department (ED) visits, home healthcare, and prescription drugs.

Method: The study used nationally representative data from the 2007-2020 Medical Expenditure Panel Survey (MEPS). Generalized linear regression models were used to estimate differences in healthcare expenditures between US-born and foreign-born individuals with ADRD, cognitive limitations without ADRD, and without ADRD or cognitive limitations. Analyses were also implemented by the immigrants' duration of residence in the US, classified as foreign-born living less than 10 years in the US and more than 10 years in the US. The study sample included all community-dwelling adult Americans and had separate subpopulation analyses on the elderly population aged 65 and above. Survey weights were applied to all estimates.

Result: Foreign-born individuals with cognitive limitations or ADRD had substantially higher total healthcare expenditures than their counterparts. Compared to US-born individuals with ADRD, foreign-born individuals with ADRD spent significantly more on home healthcare ($4,456.1, p = 0.029). Among individuals without ADRD or cognitive limitations, foreign-born individuals spent significantly less than their US-born counterparts in most healthcare services. Compared to their US-born counterparts, immigrants with ADRD who had lived in the US for more than 10 years encountered significantly higher home healthcare costs ($4,245.6, p = 0.031), whereas those who had lived in the US for less than 10 years incurred significantly lower costs on office-based visits (-$1,833.8, p<0.001) and ED visits (-$514.4, p<0.001). In contrast, immigrants with no ADRD and cognitive limitations spent significantly less than their US-born counterparts on healthcare regardless of residence duration in the US.

Conclusion: Foreign-born individuals with cognitive limitations or ADRD had substantially higher total healthcare expenditures than their US-born counterparts, while foreign-born individuals without ADRD or cognitive limitations spent significantly less than their US-born counterparts.