Dementia Mortality and Health Care Utilization Higher Among Men

Mortality rates and health care utilization are higher among men with dementia, according to findings published in JAMA Neurology.

Researchers conducted a nationwide cohort study using Medicare enrollment data from 2014 to 2021 to understand sex differences among patients with a dementia diagnosis. Participants had a dementia diagnosis code, and those with less than 1 year of continuous Medicare fee-for-service were excluded. The primary outcome was all-cause mortality, and secondary outcomes included all-cause hospitalization and other health care utilization. Cox proportional hazards models were employed for statistical analysis.

A total of 5,721,711 participants were included in the analysis. Of these, 3,302,579 were women. The mean (SD) age of the women at time of diagnosis was 81.3 (8.2) years, and 86.6% were White. A total of 2,419,132 men were included in the analysis. The mean (SD) age of the men at time of diagnosis was 79.4 (7.8) years, and 86.7% were White. Women were more likely than men to have comorbid anxiety (31.3% vs 19.9%), depression (36.2% vs 27.3%), and peripheral vascular disease (36.2% vs 27.2%). However, women were less likely than men to have comorbid cerebrovascular disease (39.4% vs 44.3%) and coronary heart disease (35.3% vs 50.7%).

Crude 1-year mortality rates were lower among women than men (21.8% vs 27.2%; P <.001), as were rates of all-cause hospitalization (46.9% vs 50.5%; P <.001). Further, at 1 year, unadjusted models showed that men had higher odds of death (hazard ratio [HR], 1.30; 95% CI, 1.29-1.31), all-cause hospitalization (HR, 1.13; 95% CI, 1.12-1.14), hospitalization for neurodegenerative diagnosis or behavioral disturbance (HR, 1.24; 95% CI, 1.20-1.29), and hospice stay (HR, 1.09; 95% CI, 1.08-1.11), and lower odds of a stay in a skilled nursing facility (HR, 0.97; 95% CI, 0.96-0.99; all P <.001) compared with women.

Risk for death remained statistically significant after adjusting for demographic and clinical characteristics, but the effects were somewhat attenuated (aHR, 1.24; 95% CI, 1.23-1.26; P <.001). A similar result was observed for the risk for all-cause hospitalization among male patients after adjustments (aHR, 1.08; 95% CI, 1.08-1.09; P <.001).

Study limitations include a claims-based design.

“Strategies to slow mortality and decrease health care use among male patients with dementia may be particularly impactful in limiting the burden of dementia,” the authors wrote.

Disclosures: Some authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.