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Association Between ICD-Coded Delirium and Health Determinants in The Atherosclerosis Risk in Communities Study.

Mfon E Umoh1, Emmanuel E Garcia Morales2,3, Wuyang Zhang4,5

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Hospitalized older adults in disadvantaged neighborhoods had higher delirium rates. Neighborhood disadvantage is a factor in delirium, but clinical and demographic factors also play a role.

Keywords:
deliriumdementiahospitalizationsocial determinants of health

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Area of Science:

  • Gerontology
  • Public Health
  • Epidemiology

Background:

  • Delirium is a common complication in hospitalized older adults, affecting 33-50% of patients over 65.
  • Little is known about the association between social determinants of health (SDOH) and delirium.
  • Neighborhood-level factors, such as socioeconomic conditions, may influence delirium risk.

Purpose of the Study:

  • To investigate the association between neighborhood disadvantage and hospitalization with delirium.
  • To examine the Area Deprivation Index (ADI) as a measure of neighborhood-level SDOH risk for delirium.

Main Methods:

  • Analysis of data from the Atherosclerosis Risk in Communities (ARIC) study, including participants from four US communities.
  • Inclusion of ARIC participants attending visit 5 (2011-2013) with at least one hospitalization before visit 7 (2018-2019).
  • Delirium identification and quantification using hospital claim records; estimation of associations between ADI quartiles and delirium incidence/number using Poisson regression, examining effects by cognitive status.

Main Results:

  • A cohort of 4130 participants included 486 (11.8%) with at least one hospitalization for delirium.
  • Unadjusted analyses showed higher delirium incidence and event numbers in the highest ADI quartile compared to the lowest.
  • Adjusted models attenuated the association; however, participants with mild cognitive impairment (MCI) and dementia from disadvantaged neighborhoods had higher delirium incidence and event numbers.

Conclusions:

  • Hospitalized older adults from disadvantaged neighborhoods exhibited a higher incidence of delirium.
  • The association between neighborhood disadvantage and delirium was attenuated in adjusted analyses, suggesting confounding factors.
  • Neighborhood-level social disadvantage is a potentially significant factor in delirium prevention and management studies.