Paid Sick Leave and the Timing of Dementia Diagnosis

• In Event: The Economics of Alzheimer’s Disease: Family Spillovers, Diagnosis, and Financial Consequences

Abstract

Introduction: Early identification of Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (AD/ADRD) improves clinical management and yields economic benefits by enabling evaluation and treatment for contributors of cognitive symptoms, earlier initiation of symptomatic or disease-modifying therapies, and person-centered care planning that reduce unplanned crises. Outpatient diagnosis, rather than diagnosis in emergency or inpatient settings, allows for more complete workups, specialist input, and more accurate detection. Because disease-modifying therapies depend on early detection and acute care is strained and costly, timely outpatient evaluation is increasingly critical. By lowering the time and income costs of outpatient care for working patients and caregivers, paid sick leave (PSL) mandates may expand management of dementia-relevant risk factors, enable earlier diagnosis, and shift care away from high-cost crisis settings. Prior research links PSL mandates to more outpatient visits, improved mental health, and reductions in emergency department (ED) use and infectious spread. Yet, there is no causal evidence on whether PSL mandates shift AD/ADRD diagnosis from ED/inpatient settings to outpatient settings.Research Question: What is the impact of PSL mandates on the timing and setting of AD/ADRD diagnoses and health care costs around diagnosis?Methods: Using 2015-2024 Merative Marketscan commercial claims and the Health and Retirement Survey linked to Medicare claims, we estimate difference-in-differences and event study models that leverage variation in the adoption of PSL mandates across states over time and are robust to heterogeneous treatment timing. The primary outcomes include age at time of ADRD diagnosis, place of service of ADRD diagnosis, and health care costs. Further, we will test for heterogeneous effects among groups with historically low PSL access. PSL access is lowest among low-wage, hourly, and service-sector workers, populations that disproportionately include racial/ethnic minorities, and dementia burden varies by race/ethnicity.Results: Preliminary findings suggest that respondents with access to PSL are less likely to report difficulty remembering or concentrating. This association remains robust after controlling for individual-level characteristics such as demographics, education, and employment. Even among younger adults, who are less likely to experience cognitive impairment, access to PSL is associated with a lower likelihood of reporting cognitive difficulties. These findings suggest that PSL access may reduce barriers to recognizing and addressing cognitive concerns, potentially facilitating earlier care-seeking and outpatient evaluation of memory-related symptoms. This pattern is consistent with the hypothesis that PSL mandates expand the capacity for employed adults to engage in preventive and diagnostic care. Ongoing analysis is examining whether these reductions in reported cognitive difficulty translate to earlier timing of AD/ADRD diagnosis in outpatient settings and changes in healthcare spending patterns around diagnosis.Implications: This research will establish whether PSL mandates causally facilitate earlier diagnoses and lower acute care around first AD/ADRD diagnosis. Timely evaluation of cognitive symptoms enables detection and treatment of modifiable risk factors for dementia (e.g., medication effects, depression, diabetes), earlier initiation of disease-modifying therapies, and comprehensive care planning (safety, medication management, advance directives, caregiver support) that may reduce unplanned crises, with potential downstream reductions in avoidable hospitalizations and long-term care.

Author

• Katherine J Wen, Vanderbilt University
  Presenting Author