(157) Changes in Multimorbidity Burden and Healthcare Utilization Before and After a Diagnosis of Dementia: A Claim-Based Nationwide Cohort Study

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 831

Presenting Author(s)

Shih-Tsung Huang, PharmD
– Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan

Co-Author(s)

Liang-Kung Chen
– Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan, Taipei, Taiwan, Taiwan (Republic of China)
Fei-Yuan Hsiao
– Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan (Republic of China)

Background: Characterization of the dynamic changes in burden of comorbidities and healthcare utilizations before and after dementia diagnosis is crucial in addressing the care needs of people with dementia.

Objectives: The objective of this study was to evaluate the dynamic changes in comorbidity and healthcare utilization among incident dementia patients in Taiwan.

Methods: People aged 65 years or older and newly diagnosed with dementia (ICD-9-CM codes 290, 294, 331.0-331.2, 331.82, 331.89, 331.9; ICD-10-CM codes: F01-F04, G30, G31) between 2004 and 2013 were identified from the National Health Insurance Research Database. To describe the changes of comorbidity before and after dementia diagnosis, we selected 22 common diseases/conditions in dementia patients and used normalization method based on prevalence at baseline to capture the changes in these diseases/conditions 3 years before and 5 years after diagnosis of dementia. Number of outpatient visits, emergency room visits, admissions (including length of stay), and psychotropic mediation uses during the same observational period were also estimated.

Results: Dementia patients were more likely to have comorbidity after the diagnosis of dementia compared to baseline. During the 5-years of follow-up, the prevalence of schizophrenia, depression, Parkinson disease, and anxiety, increased by 153.1%, 150.6%, 146.3%, and 94.9%, respectively. The prevalence of other comorbidities also increased by approximately 65% to 110% compared to baseline. In addition, patients were more likely to have delirium, fracture, insomnia, and ulcer both at baseline and 1st year after the diagnosis of dementia.
For health care utilization, we found that patients with incident dementia have increased demands 1 year prior to the diagnosis of dementia. For example, the proportion of patients with any hospitalization started to increase during 1 year prior to the diagnosis of dementia (-3 year: 23.1%, -2 year: 25.8%, and -1 year: 40.3%). After the diagnosis of dementia, the probability of admission also increased in the 1st year (54.2%), then decreased and remained stable between the 2nd and the 5th year (from 39.4% at 2nd year to 37.4% at 5th year) after diagnosis. Uses of psychotropic medications gradually increased in the past 3 years before dementia diagnosis, peaked at the 1st quarter after the diagnosis of dementia, gradually decreased during the first two years, and then remained stable after the 2nd year after the diagnosis of dementia.

Conclusions: Our study provided real-world evidence regarding the early emergence of healthcare needed and the burden of multi-comorbidities among dementia patients. Early detection of these needs are warranted to better taking care of people with dementia.