Trends and Disparities in Dementia- and Sepsis-Related Mortality in Older U.S. Adults (1999-2020)

This observational study evaluated demographic and regional disparities in mortality due to dementia with comorbid sepsis among older adults (≥65 years) in the United States from 1999 to 2020.

We analyzed death certificate data from the CDC WONDER Multiple Cause of Death database (1999-2020). Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated and standardized to the 2000 U.S.

Temporal trends were assessed using Joinpoint regression to estimate annual percentage change (APC) and average annual percent change (AAPC). Analyses were stratified by age, sex, race/ethnicity, geographic region, and urban-rural classification.

Between 1999 and 2020, dementia with comorbid sepsis accounted for 284,645 deaths, yielding an overall AAMR of 30.8 (95% confidence interval: 30.7-30.9). Overall mortality remained stable (AAPC: 0.20%; 95% CI: -0.19 to 0.60). Males had higher mortality than females (AAMR: 31.8 vs. 30.0). Non-Hispanic Black individuals experienced the greatest burden (AAMR: 51.8), whereas Hispanic and non-Hispanic Asian/Pacific Islander populations demonstrated the steepest mortality increases. Crude mortality was highest among adults aged ≥85 years (136.1 per 100,000), while the largest relative increase occurred in those aged 75-84 years. The South exhibited the highest regional mortality (AAMR: 35.8), and rural areas showed elevated rates (AAMR: 31.7).

Although mortality remained stable, disparities persist across demographic and geographic subgroups. Targeted interventions are needed to reduce inequities and mitigate mortality associated with dementia and sepsis in older adults.