Aging
Healthcare utilization and morbidity preceding a dementia diagnosis. The Atherosclerosis Risk in Communities (ARIC) Study. Meng Pan* Meng Pan David Knopman Michele Johnson-Funk Priya Palta Anna Kucharska-Newton
Objectives: To compare healthcare utilization among persons living with dementia (PLWD) and those cognitively normal.
Methods: Within a retrospective cohort of ARIC Visit 6 (2016-2017) participants with continuous Medicare fee-for-service enrollment (2011-2018), Poisson regression was used to compare longitudinal trends in inpatient, Emergency Department (ED), and ambulatory care use in the 5 years prior to and 1 year following a comprehensive syndromic . Inverse probability weights were used to balance groups of participants with and without dementia on baseline age, race, sex, education, and prevalent comorbidities [diabetes, congestive heart failure (CHF), stroke, and coronary heart disease]. Principal discharge diagnosis codes were used to assess the prevalence of Centers for Medicare & Medicaid Services pre-defined chronic conditions associated with each healthcare visit.
Results: Among 3,932 eligible participants at ARIC visit 6 (median age 79 years old, 325 (8.3%) with incident dementia), 59% were women and 24% were Black. During 5 years prior to a dementia diagnosis, participants with, as compared to those without dementia, had on average greater utilization of inpatient (0.11 vs 0.08 hospitalizations) and ED services (0.26 vs 0.18 visits) but lower ambulatory care use (3.53 vs 3.76 visits). (Figure) The most frequent principal diagnoses for inpatient visits occurring within 6 months prior to the diagnosis were CHF (6.4%), ischemic heart disease (5.8%), and stroke/transient ischemic attack (5.8%) among participants with dementia, and rheumatoid arthritis/osteoarthritis (8.8%), CHF (4.3%), and chronic kidney disease (4.1%) among participants without dementia.
Conclusion: Inpatient and ED utilization were on average greater among PLWD as compared to those cognitively normal, while the ambulatory care utilization were on average lower among PLWD.
