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Trajectory of Cardiometabolic Disease-Related Hospitalizations Before and After Dementia Diagnosis: A Matched Cohort
Sakura Sakakibara1, Abigail Dove1, Michelle M Dunk1
1Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
Insights
Hospitalizations for cardiometabolic diseases (CMDs) increase years before dementia diagnosis and decrease afterward. Factors like male sex, smoking, obesity, and hypertension worsen this trend in dementia patients.
Area of Science:
- Gerontology
- Neurology
- Cardiology
Background:
- Dementia significantly increases healthcare utilization.
- Cardiometabolic diseases (CMDs) frequently co-occur with dementia.
- The relationship between dementia progression and CMD-related hospitalizations is not well understood.
Purpose of the Study:
- To analyze the pattern of hospitalizations related to cardiometabolic diseases (CMDs) before and after dementia diagnosis.
- To identify factors associated with CMD-related hospitalizations in individuals with dementia.
Main Methods:
- A matched cohort study was conducted using the Swedish Twin Registry.
- 1657 participants with incident dementia were matched with 1657 dementia-free controls.
- Participants were followed for up to 20 years, analyzing CMD-related hospitalizations using Poisson regression and generalized estimating equation models.
Main Results:
- CMD-related hospitalizations increased from 4 years prior to dementia diagnosis and decreased 3 years post-diagnosis.
- Individuals with dementia experienced more CMD-related hospitalizations and longer hospital stays in the 5 years preceding diagnosis.
- Male sex, smoking, obesity, and hypertension were linked to increased CMD-related hospitalizations in dementia patients.
Conclusions:
- Hospitalization patterns for CMDs change significantly during dementia development.
- Increased healthcare burden, indicated by CMD-related hospitalizations, can manifest even before a dementia diagnosis.
- CMD-related hospitalizations may serve as an early indicator for future dementia onset.
Objectives:
Dementia is associated with increased health care use; however, the timing of hospitalizations in relation to the development of dementia remains unclear. Cardiometabolic diseases (CMDs) including type 2 diabetes, heart disease, and stroke often co-occur with dementia, but the impact of dementia on hospitalizations related to CMDs remains unknown. We aimed to map the trajectory of CMD-related hospitalization before and after dementia diagnosis and to further identify factors of CMD-related hospitalization.
Design:
Matched cohort study.
Setting And Participants:
Within the Swedish Twin Registry, 1657 participants aged ≥65 years (58.8% women) with incident dementia were matched with 1657 dementia-free participants using propensity scores.
Methods:
Participants were followed for up to 20 years to detect CMD-related hospitalizations. Dementia and CMD-related hospitalizations (both planned and unplanned) were identified from medical records. Potential related factors included age, sex, education, marital status, smoking, drinking, physical activity, body mass index, and hypertension. Data were analyzed using Poisson regression and generalized estimating equation models.
Results:
Compared with the control patients, the incidence of CMD-related hospitalization among people with dementia started to increase from 4 years before [incidence rate ratio (IRR), 1.25; 95% CI, 1.00-1.57], and started to decrease 3 years after, the diagnosis (IRR, 0.74; 95% CI, 0.58-0.94). People with dementia had a greater number of CMD-related hospitalizations (IRR, 1.19; 95% CI, 1.04-1.36) and longer cumulative length of stay (IRR, 1.27; 95% CI, 1.04-1.56) in the 5 years before dementia diagnosis, but these rates decreased after the diagnosis. Male sex, smoking, obesity, and hypertension were associated with further increases in CMD-related hospitalization among people with dementia.
Conclusions And Implications:
Patterns of CMD-related hospitalization change over the course of dementia development. Our findings suggest that the health care burden increases even before the diagnosis of dementia, and CMD-related hospitalization may be an early sign of the future onset of dementia.
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