RESUMO
BACKGROUND: Hispanic older adults are a high-risk population for Alzheimer's disease and related dementias (ADRD) but are less likely than non-Hispanic White older adults to have ADRD documented as a cause of death on a death certificate. OBJECTIVE: To investigate characteristics associated with ADRD as a cause of death among Mexican-American decedents diagnosed with ADRD. METHODS: Data came from the Hispanic Established Populations for the Epidemiologic Study of the Elderly, Medicare claims, and National Death Index. RESULTS: The final sample included 853 decedents diagnosed with ADRD of which 242 had ADRD documented as a cause of death. More health comorbidities (ORâ=â0.40, 95% CIâ=â0.28-0.58), older age at death (ORâ=â1.18, 95% CIâ=â1.03-1.36), and longer ADRD duration (ORâ=â1.08, 95% CIâ=â1.03-1.14) were associated with ADRD as a cause of death. In the last year of life, any ER admission without a hospitalization (ORâ=â0.45, 95% CIâ=â0.22-0.92), more physician visits (ORâ=â0.96, 95% CIâ=â0.93-0.98), and seeing a medical specialist (ORâ=â0.46, 95% CIâ=â0.29-0.75) were associated with lower odds for ADRD as a cause of death. In the last 30 days of life, any hospitalization with an ICU stay (ORâ=â0.55, 95% CIâ=â0.36-0.82) and ER admission with a hospitalization (ORâ=â0.67, 95% CIâ=â0.48-0.94) were associated with lower odds for ADRD as a cause of death. Receiving hospice care in the last 30 days of life was associated with 1.98 (95% CIâ=â1.37-2.87) higher odds for ADRD as a cause of death. CONCLUSION: Under-documentation of ADRD as a cause of death may reflect an underestimation of resource needs for Mexican-Americans with ADRD.
Assuntos
Causas de Morte , Comorbidade , Demência/mortalidade , Documentação/normas , Americanos Mexicanos/estatística & dados numéricos , Fatores Etários , Idoso de 80 Anos ou mais , Feminino , Hospitais para Doentes Terminais , Hospitalização , Humanos , Revisão da Utilização de Seguros , Masculino , Medicare , Estados UnidosRESUMO
BACKGROUND: Dementia is the main cause of disability in older people living in low- and middle-income countries (LMIC). Monitoring mortality rates and mortality risk factors in people with dementia (PwD) may contribute to improving care provision. OBJECTIVE: We aimed to estimate mortality rates and mortality predictors in PwD from eight LMICs. METHODS: This 3-5-year prospective cohort study involved a sample of 1,488 older people with dementia from eight LMIC. Total, age- and gender-specific mortality rates per 1,000 person-years at risk, as well as the total, age- and gender-adjusted mortality rates were estimated for each country's sub-sample. Cox's regressions were used to establish the predictors of mortality. RESULTS: At follow-up, vital status of 1,304 individuals (87.6%) was established, of which 593 (45.5%) were deceased. Mortality rate was higher in China (65.9%) and lower in Mexico (26.9%). Mortality risk was higher in males (HRâ=â1.57; 95% CI: 1.32,1.87) and increased with age (HRâ=â1.04; 95% CI: 1.03,1.06). Neuropsychiatric symptoms (HRâ=â1.03; 95% CI: 1.01,1.05), cognitive decline (HR 1.04; 95% CI: 1.03,1.05), undernutrition (HRâ=â1.55; 95% CI: 1.19, 2.02), physical impairments (HRâ=â1.15; 95% CI: 1.03,1.29), and disease severity (HRâ=â1.43; 95% CI: 1.22,1.63) predicted higher mortality risk. CONCLUSION: Several factors predicted higher mortality risk in PwD in LMICs. Males, those with higher age, higher severity of neuropsychiatric symptoms, higher number of physical impairments, higher disease severity, lower cognitive performance, and undernutrition had higher mortality risk. Addressing these indicators of long-term adverse outcomes may potentially contribute to improved advanced care planning, reducing the burden of disease in low-resourced settings.
Assuntos
Demência/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Países em Desenvolvimento , Feminino , Humanos , Masculino , Mortalidade , Estudos Prospectivos , Fatores de Risco , Fatores SexuaisRESUMO
This paper provides estimates of mortality rates from Alzheimer's disease dementia (AD) in the elderly Brazilian population. Data were obtained from the 2010 Population Census by Brazilian Institute of Geography and Statistics (IBGE) and microdata on mortality in Brazil's 27 state capitals recorded in the Brazilian Mortality Information System (SIM) for the population 65 years or older by place of residence for the years 2009 to 2013. Corrections were obtained for underreporting of mortality, and final adjustments were made to the specific mortality rates based on Bayesian methods with prior probability distributions built on the basis of information obtained from a meta-analysis. The mortality rates from all dementias and from AD in Brazil were higher than in developed countries. The mortality rates from Alzheimer's disease in 2013 were 140.03 (95%CI: 117.05; 166.4) and 127.07 (95%CI: 103.74; 149.62) per 100,000 inhabitants, respectively, in men and women. The contribution of AD to mortality in elderly Brazilians was 4.4% (95%CI: 3.25; 5.72) in the group with 0 to 3 years of schooling, independently of age and sex. The study aimed to increase knowledge on corrected estimates of mortality rates from Alzheimer's disease based on vital statistics, providing more precise and pertinent evidence-based estimates.
Este artículo proporciona estimaciones de las tasas de mortalidad por la demencia por la enfermedad de Alzheimer (DA) en población adulta mayor. Para ello, se usaron datos del Censo Demográfico de 2010 del Instituto Brasileño de Geografía y Estadística (IBGE) y microdatos de mortalidad de las 27 capitales de los estados brasileños, registradas en el Sistema de Informaciones sobre Mortalidad (SIM) del Ministerio de Salud de Brasil, en población con 65 años o más por lugar de residencia, entre los años 2009 y 2013. Se obtuvieron correcciones de los subregistros de mortalidad y ajustes finales de las tasas específicas de mortalidad, a partir de métodos bayesianos, con distribuciones de probabilidad a priori, construidas en base a información obtenida desde metaanálisis. Se destaca que las tasas por demencia y DA en Brasil fueron superiores a las obtenidas en países desarrollados. Las tasas de mortalidad por Alzheimer en 2013 fueron de 140,03 (IC95%: 117,05; 166,4) y 127,07 (IC95%: 103,74; 149,62) por 100.000 habitantes, respectivamente, en hombres y mujeres. La contribución de la DA a la mortalidad adulta mayor en el Brasil fue 4,4% (IC95%: 3,25; 5,72), en el grupo de personas de 0 a 3 años de estudio, independiente de la edad y sexo. Nuestras contribuciones fueron dirigidas a aumentar el conocimiento en estimaciones corregidas de las tasas de mortalidad por Alzheimer con base en estadísticas vitales, proporcionando estimaciones más precisas y pertinentes, fundamentadas en el método científico.
Este artigo oferece estimativas das taxas de mortalidade devidas à demência pela doença de Alzheimer (DA) na população idosa brasileira. Para isso, foram usados dados do Censo de Demográfico de 2010 do Instituto Brasileiro de Geografia e Estatística (IBGE) e microdados de mortalidade das 27 capitais dos estados brasileiros, registradas no Sistema de Informações sobre Mortalidade (SIM) do Ministério da Saúde, em população com 65 anos ou mais por local de residência, entre os anos de 2009 e 2013. Foram obtidas correções dos sub-registros de mortalidade e ajustes finais das taxas específicas de mortalidade, a partir de métodos bayesianos, com distribuições de probabilidade a priori, construídas em base a informações obtidas via meta-análises. Foi destacado que as taxas por demência e DA no Brasil foram superiores às obtidas em países desenvolvidos. As taxas de mortalidade por Alzheimer em 2013 foram de 140,03 (IC95%: 117,05; 166,4) e 127,07 (IC95%: 103,74; 149,62) por 100 mil habitantes, respectivamente, em homens e mulheres. A contribuição da DA para a mortalidade em idosos no Brasil foi 4,4% (IC95%: 3,25; 5,72), em um grupo de pessoas com 0 a 3 anos de estudo, independentemente da idade ou sexo. Nossas contribuições foram dirigidas a aumentar o conhecimento em estimativas corrigidas das taxas de mortalidade por Alzheimer com base em estatísticas vitais, proporcionando estimativas mais precisas e pertinentes, fundamentadas no método científico.
Assuntos
Doença de Alzheimer/mortalidade , Demência/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/complicações , Doença de Alzheimer/diagnóstico , Teorema de Bayes , Brasil/epidemiologia , Causas de Morte , Demência/diagnóstico , Demência/etiologia , Feminino , Sistemas de Informação em Saúde , Humanos , Masculino , Mortalidade/tendências , Características de Residência , Fatores de RiscoRESUMO
OBJECTIVE: To examine cause-specific mortality beyond cardiovascular diseases (CVDs) in patients with gout compared to the general population. METHODS: We included all residents of Skåne (Sweden) age ≥18 years in the year 2002. Using the Skåne Healthcare Register, we identified subjects with a new diagnosis of gout (2003-2013) and matched each person with gout with 10 comparators free of gout, by age and sex. We used information on the underlying cause of death from the Swedish Cause of Death Register (through December 31, 2014) to estimate hazard ratios (HRs, with 95% confidence intervals [95% CIs]) of mortality for specific causes of death in a multi-state Cox model, with adjustment for potential confounders. RESULTS: Among 832,258 persons, 19,497 had a new diagnosis of gout (32% women) and were matched with 194,947 comparators. Subjects with gout had higher prevalence of chronic kidney disease, metabolic disease, and CVD. Gout was associated with 17% increased hazard of all-cause mortality overall (HR 1.17 [95% CI 1.14-1.21]), 23% in women (HR 1.23 [95% CI 1.17-1.30]), and 15% in men (HR 1.15 [95% CI 1.10-1.19]). In terms of cause-specific mortality, the strongest associations were seen in the relationship of gout to the risk of death due to renal disease (HR 1.78 [95% CI 1.34-2.35]), diseases of the digestive system (HR 1.56 [95% 1.34-1.83]), CVD (HR 1.27 [95% CI 1.22-1.33]), infections (HR 1.20 [95% CI 1.06-1.35]), and dementia (HR 0.83 [95% CI 0.72-0.97]). CONCLUSION: Several non-CV causes of mortality are increased in persons with gout, emphasizing the need for improved management of comorbidities.
Assuntos
Doenças Cardiovasculares/mortalidade , Demência/mortalidade , Diabetes Mellitus/mortalidade , Doenças do Sistema Digestório/mortalidade , Gota/epidemiologia , Infecções/mortalidade , Insuficiência Renal Crônica/mortalidade , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Estudos de Casos e Controles , Causas de Morte , Demência/epidemiologia , Diabetes Mellitus/epidemiologia , Doenças do Sistema Digestório/epidemiologia , Feminino , Humanos , Infecções/epidemiologia , Pneumopatias/epidemiologia , Pneumopatias/mortalidade , Masculino , Pessoa de Meia-Idade , Mortalidade , Neoplasias/epidemiologia , Neoplasias/mortalidade , Modelos de Riscos Proporcionais , Insuficiência Renal Crônica/epidemiologia , Suécia/epidemiologiaRESUMO
Este artículo proporciona estimaciones de las tasas de mortalidad por la demencia por la enfermedad de Alzheimer (DA) en población adulta mayor. Para ello, se usaron datos del Censo Demográfico de 2010 del Instituto Brasileño de Geografía y Estadística (IBGE) y microdatos de mortalidad de las 27 capitales de los estados brasileños, registradas en el Sistema de Informaciones sobre Mortalidad (SIM) del Ministerio de Salud de Brasil, en población con 65 años o más por lugar de residencia, entre los años 2009 y 2013. Se obtuvieron correcciones de los subregistros de mortalidad y ajustes finales de las tasas específicas de mortalidad, a partir de métodos bayesianos, con distribuciones de probabilidad a priori, construidas en base a información obtenida desde metaanálisis. Se destaca que las tasas por demencia y DA en Brasil fueron superiores a las obtenidas en países desarrollados. Las tasas de mortalidad por Alzheimer en 2013 fueron de 140,03 (IC95%: 117,05; 166,4) y 127,07 (IC95%: 103,74; 149,62) por 100.000 habitantes, respectivamente, en hombres y mujeres. La contribución de la DA a la mortalidad adulta mayor en el Brasil fue 4,4% (IC95%: 3,25; 5,72), en el grupo de personas de 0 a 3 años de estudio, independiente de la edad y sexo. Nuestras contribuciones fueron dirigidas a aumentar el conocimiento en estimaciones corregidas de las tasas de mortalidad por Alzheimer con base en estadísticas vitales, proporcionando estimaciones más precisas y pertinentes, fundamentadas en el método científico.
Este artigo oferece estimativas das taxas de mortalidade devidas à demência pela doença de Alzheimer (DA) na população idosa brasileira. Para isso, foram usados dados do Censo de Demográfico de 2010 do Instituto Brasileiro de Geografia e Estatística (IBGE) e microdados de mortalidade das 27 capitais dos estados brasileiros, registradas no Sistema de Informações sobre Mortalidade (SIM) do Ministério da Saúde, em população com 65 anos ou mais por local de residência, entre os anos de 2009 e 2013. Foram obtidas correções dos sub-registros de mortalidade e ajustes finais das taxas específicas de mortalidade, a partir de métodos bayesianos, com distribuições de probabilidade a priori, construídas em base a informações obtidas via meta-análises. Foi destacado que as taxas por demência e DA no Brasil foram superiores às obtidas em países desenvolvidos. As taxas de mortalidade por Alzheimer em 2013 foram de 140,03 (IC95%: 117,05; 166,4) e 127,07 (IC95%: 103,74; 149,62) por 100 mil habitantes, respectivamente, em homens e mulheres. A contribuição da DA para a mortalidade em idosos no Brasil foi 4,4% (IC95%: 3,25; 5,72), em um grupo de pessoas com 0 a 3 anos de estudo, independentemente da idade ou sexo. Nossas contribuições foram dirigidas a aumentar o conhecimento em estimativas corrigidas das taxas de mortalidade por Alzheimer com base em estatísticas vitais, proporcionando estimativas mais precisas e pertinentes, fundamentadas no método científico.
This paper provides estimates of mortality rates from Alzheimer's disease dementia (AD) in the elderly Brazilian population. Data were obtained from the 2010 Population Census by Brazilian Institute of Geography and Statistics (IBGE) and microdata on mortality in Brazil's 27 state capitals recorded in the Brazilian Mortality Information System (SIM) for the population 65 years or older by place of residence for the years 2009 to 2013. Corrections were obtained for underreporting of mortality, and final adjustments were made to the specific mortality rates based on Bayesian methods with prior probability distributions built on the basis of information obtained from a meta-analysis. The mortality rates from all dementias and from AD in Brazil were higher than in developed countries. The mortality rates from Alzheimer's disease in 2013 were 140.03 (95%CI: 117.05; 166.4) and 127.07 (95%CI: 103.74; 149.62) per 100,000 inhabitants, respectively, in men and women. The contribution of AD to mortality in elderly Brazilians was 4.4% (95%CI: 3.25; 5.72) in the group with 0 to 3 years of schooling, independently of age and sex. The study aimed to increase knowledge on corrected estimates of mortality rates from Alzheimer's disease based on vital statistics, providing more precise and pertinent evidence-based estimates.
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Demência/mortalidade , Doença de Alzheimer/mortalidade , Brasil/epidemiologia , Características de Residência , Fatores de Risco , Mortalidade/tendências , Teorema de Bayes , Causas de Morte , Fatores Etários , Demência/diagnóstico , Demência/etiologia , Doença de Alzheimer/complicações , Doença de Alzheimer/diagnóstico , Sistemas de Informação em SaúdeRESUMO
We aimed to compare the mortality risk between patients with affective disorders and dementia under treatment with antipsychotics. To do this, a matched-cohort study based on an electronic database of a tertiary teaching hospital in Argentina was performed. Antipsychotic exposure was defined as any antipsychotic drug initiated by the patient. Primary outcome was defined as all-cause mortality during the 5-year follow-up period. To estimate the association between baseline diagnosis (affective disorders vs. dementia) and all-cause mortality, we used a multivariate generalized linear model with robust standard errors. Of 1008 eligible patients, 114 age-matched pairs were included in the present study. The primary event occurred in 23 patients (20%) and 17 patients (15%) in the dementia and affective disorder group respectively. In the adjusted model, the risk of all cause mortality for the affective disorders group was 0.92 times the risk for the dementia group (95%CI, 0.54-1.59, pâ¯=â¯0.77). In conclusion, older patients with affective disorders starting antipsychotic treatment presented with a similar risk of all-cause mortality during the 5-year follow-up when compared to older patients with dementia who were also initiating either typical or atypical antipsychotic medications. Closer medical attention to older patients with mental conditions under antipsychotic treatment remains warranted.
Assuntos
Antipsicóticos/efeitos adversos , Demência/tratamento farmacológico , Demência/mortalidade , Transtornos do Humor/tratamento farmacológico , Transtornos do Humor/mortalidade , Idoso , Idoso de 80 Anos ou mais , Antipsicóticos/uso terapêutico , Argentina/epidemiologia , Causas de Morte/tendências , Estudos de Coortes , Bases de Dados Factuais/tendências , Demência/psicologia , Feminino , Humanos , Masculino , Transtornos do Humor/psicologia , Mortalidade/tendências , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Heart failure (HF) and dementia are major causes of disability and death among older individuals. Risk factors and biomarkers of HF may be determinants of dementia in the elderly. We evaluated the relationship between biomarkers of cardiovascular disease and HF and risk of dementia and death. Three hypotheses were tested: (1) higher levels of high-sensitivity cardiac troponin T, N-terminal of prohormone brain natriuretic peptide, and cystatin C predict risk of death, cardiovascular disease, HF, and dementia; (2) higher levels of cardiovascular disease biomarkers are associated with increased risk of HF and then secondary increased risk of dementia; and (3) risk of dementia is lower among participants with a combination of lower coronary artery calcium, atherosclerosis, and lower high-sensitivity cardiac troponin T (myocardial injury). METHODS AND RESULTS: The Cardiovascular Health Study Cognition Study was a continuation of the Cardiovascular Health Study limited to the Pittsburgh, PA, center from 1998-1999 to 2014. In 1992-1994, 924 participants underwent magnetic resonance imaging of the brain. There were 199 deaths and 116 developed dementia before 1998-1999. Of the 609 participants eligible for the Pittsburgh Cardiovascular Health Study Cognition Study, 87.5% (n=532) were included in the study. There were 120 incident HF cases and 72% had dementia. In 80 of 87, dementia preceded HF. A combination of low coronary artery calcium score and low high-sensitivity cardiac troponin T was significantly associated with reduced risk of dementia and HF. CONCLUSIONS: Most participants with HF had dementia but with onset before HF. Lower high-sensitivity cardiac troponin T and coronary artery calcium was associated with low risk of dementia based on a small number of events. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005133.
Assuntos
Envelhecimento , Aterosclerose/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Demência/epidemiologia , Insuficiência Cardíaca/epidemiologia , Coração/fisiopatologia , Nefropatias/epidemiologia , Rim/fisiopatologia , Calcificação Vascular/epidemiologia , Fatores Etários , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Aterosclerose/diagnóstico , Aterosclerose/mortalidade , Aterosclerose/fisiopatologia , Biomarcadores/sangue , Causas de Morte , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Cistatina C/sangue , Demência/diagnóstico , Demência/mortalidade , Demência/fisiopatologia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Incidência , Nefropatias/diagnóstico , Nefropatias/mortalidade , Nefropatias/fisiopatologia , Imageamento por Ressonância Magnética , Masculino , Peptídeo Natriurético Encefálico/sangue , Testes Neuropsicológicos , Pennsylvania/epidemiologia , Fragmentos de Peptídeos/sangue , Prevalência , Fatores de Risco , Fatores de Tempo , Troponina T/sangue , Calcificação Vascular/diagnóstico , Calcificação Vascular/mortalidade , Calcificação Vascular/fisiopatologiaRESUMO
BACKGROUND: Dementia risk is reported as being higher in the north compared to the south, which may be related to vitamin D deficiency. If this were the case, an opposite gradient of risk would be observed in the southern hemisphere, but this has not been investigated previously. METHODS: We calculated standardised mortality ratios (SMRs) for deaths in 2012 where dementia (Alzheimer's disease, vascular or unspecified dementia) was recorded as the underlying cause for 20 regions in Italy, 20 District Health Board areas in New Zealand and 29 Health Service areas in Chile. RESULTS: Dementia SMRs were higher in northern than central or southern Italy. The inverse pattern was seen in women in New Zealand, with rates higher on South Island than North Island. However, dementia risk was raised in eight regions in the north and centre of Chile in both men and women. CONCLUSIONS: Geographical variation plays a key role in dementia risk, but patterns vary in men and women. In the northern hemisphere, dementia mortality is higher in the north, but the pattern in the southern hemisphere is more complex.
Assuntos
Poluição do Ar/efeitos adversos , Demência , Vitamina D/análise , Adulto , Chile/epidemiologia , Demência/diagnóstico , Demência/mortalidade , Exposição Ambiental/estatística & dados numéricos , Feminino , Geografia , Humanos , Itália/epidemiologia , Masculino , Testes Neuropsicológicos , Nova Zelândia/epidemiologia , Fatores de Risco , Fatores SexuaisAssuntos
Nível de Saúde , Casas de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Doenças Cardiovasculares/mortalidade , Demência/mortalidade , Diabetes Mellitus/mortalidade , Feminino , Humanos , Hiperlipidemias/mortalidade , Hipertensão/mortalidade , Modelos Logísticos , Neoplasias/mortalidade , Prognóstico , Estudos Prospectivos , Taxa de SobrevidaRESUMO
UNLABELLED: We describe a three-year experience with patients with dementia. METHOD: clinical, cognitive and functional evaluation was performed by a multidisciplinary team for persons above 60 years. Mortality was assessed after three years. RESULTS: Mini-Mental State Examination (MMSE) (n=2,074) was 15.7 (8.4). Male patients MMSE (n=758) was 15.6 (8.3) and female's (n=1315) was 15.8 (8.3). Instrumental Activities of Daily Living Scale (n=2023) was 16.5 (7.6); females (n=1277) was 16.9 (7.2) and males (n=745) was 15.7(8.2). From these patients, 12.6% (n=209) died within three years. Baseline cognition of patients still alive was higher (p<0.001) than MMSE of those who died [MMSE=16.3 (8.1) vs. 10.6 (7.6)]. Mortality rate decreased 6% (IR=0.94) for each additional point on MMSE. Higher functional status decreases the mortality rate approximately 11% (IR=0.89) independently of age, gender, and education. CONCLUSION: Three-year mortality rates are dependent on baseline functional and cognitive status.