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P2‐071: Increased risk of serious comorbidities in a cohort of AD patients compared to a similar non‐AD cohort
Author(s) -
Malone Daniel,
Mucha Lisa,
McLaughlin Trent,
Sklar Ami,
Harley Carolyn
Publication year - 2009
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2009.04.381
Subject(s) - medicine , cohort , dementia , incidence (geometry) , diabetes mellitus , hyperlipidemia , pediatrics , disease , population , cohort study , physics , environmental health , optics , endocrinology
Background: Elderly persons often have multiple conditions that increase the complexity of care. The literature on the relationship between Alzheimer’s Disease (AD) and prevalence of other serious conditions is sparse. The study objective was to examine the association between serious health conditions and AD among an insured population residing in the United States. Methods: Medical and pharmacy administrative data for over 33 million Americans from July 1, 1999 to December 31, 2007 were analyzed. Persons with a diagnosis of AD were identified and followed for 6 months prior to their initial AD claim (index date) through at least 12 months after. Inclusion criteria also included age 40þ and survival of >12 months after the index date. A comparison cohort without evidence of AD or dementia was matched based on age, sex, health plan type, index quarter/year and length of follow-up. Analyses examined the incidence of 17 pre-specified comorbidities/events, including mental health conditions, injuries, decubitus ulcers, diabetes, hyperlipidemia, hypertension, Parkinson’s, epilepsy, anemia, and malnutrition based on diagnosis codes. Incident rate ratios (IRR) were estimated for each condition between those with and without AD. Results: 10,576 subjects with AD and 10,576 matched non-AD subjects were identified. Overall, 59% were female and the average age was 76 years. Mean (SD) follow-up time was 823 (436) days in both cohorts. The most frequent conditions at baseline in both groups were hypertension (AD:46%, nonAD:45%), hyperlipidemia (AD:33%, non-AD:36%), and osteoarthritis (AD:17%, non-AD:16%). The highest IRRs (AD/matched) were psychosis (IRR:13.6, 95%CI:11.5-16.2); Parkinson’s Disease (IRR:9.6, 95%CI:7.712.1), decubitus ulcer (IRR:5.2, 95%CI:4.4-6.0), epilepsy (IRR:4.4, 95%CI:4.1-4.7), depression (IRR:3.9, 95%CI:3.6-4.2), hip fractures (IRR:3.6, 95%CI:2.9-3.9), and pneumonia (IRR:2.3, 95%CI:2.2-2.5) where an IRR >1.0 indicates increased rates in the AD cohort. The IRRs were significant and greater than 1.0 for all comorbidities except for diabetes and hyperlipidemia. Conclusions: AD patients appear to have a higher prevalence of other serious conditions compared to patients without AD. Most notable in this study was the higher incidence of decubitus ulcers, seizures, hip factures, depression, and pneumonia, all having IRRs greater than 2.00 indicating substantial risk among persons with AD relative to those without AD.