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Overall and cause-specific mortality in patients with dementia: a population-based cohort study in Taiwan
Chia-Lun Kuo, Pei-Chen Lee, Li-Jung Elizabeth Ku, Yu Sun, Tsung-Hsueh Lu, Muhammad Atoillah Isfandiari, Chung-Yi Li
Epidemiol Health. 2023;45:e2023082.   Published online August 31, 2023
DOI: https://doi.org/10.4178/epih.e2023082
  • 3,068 View
  • 107 Download
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Information regarding the underlying causes of death (UCODs) and standardized mortality ratio (SMR) of dementia is instrumental in formulating medical strategies to prolong life in persons with dementia (PWD). We examined the leading UCODs among PWD and estimated the overall and cause-specific SMRs in relation to dementia in Taiwan.
METHODS
Data were retrieved from 2 national datasets: the Taiwan Death Registry and the medical claim datasets of the National Health Insurance program. The observed person-years for each study participant were counted from the date of cohort enrollment to either the date of death or the final day of 2016. Sex-specific and age-specific SMRs were then calculated.
RESULTS
The leading UCOD was circulatory disease, accounting for 26.0% of total deaths (n=3,505), followed by respiratory disease at 21.3% (n=2,875). PWD were at significantly increased risk of all-cause mortality (SMR, 2.01), with SMR decreasing with advancing age. A cause-specific analysis revealed that the highest SMRs were associated with nervous system diseases (SMR, 7.58) and mental, behavioral, and neurodevelopmental disorders (SMR, 4.80). Age appeared to modify SMR, suggesting that younger age at cohort enrollment was linked to higher SMRs for nearly all causes of mortality.
CONCLUSIONS
Circulatory and respiratory diseases were the leading UCODs among PWD. The particularly elevated mortality due to nervous system diseases and mental disorders suggests that allocating more resources to neurological and psychiatric services is warranted. The elevated SMRs of various UCODs among younger PWD underscore the need for clinicians to pay particular attention to the medical care provided to these patients.
Summary
Key Message
Circulatory diseases were the leading causes of death in patients with dementia (PWD) in Taiwan, which accounted for 26% of the total deaths, followed by diseases of the respiratory system (21.32%). PWD were at a significantly increased risk of all-cause mortality (SMR: 2.01). A greater increase in cause specific SMR was noted for nervous system diseases (SMR: 7.58) and mental, behavioral and neurodevelopmental disorders (SMR: 4.80). Age tended to modify the SMRs in PWD, which indicated the younger the age of cohort enrollment was, the higher the SMRs of nearly all causes of mortality were.

Citations

Citations to this article as recorded by  
  • Trends in incidence, mortality, dynamic needs and rapid evolution of healthcare in dementia
    Ke-Zong Ma, Chaur-Jong Hu
    Archives of Gerontology and Geriatrics.2024; 121: 105389.     CrossRef
Risk of dementia according to the severity of chronic periodontitis in Korea: a nationwide retrospective cohort study
Seon-Rye Kim, Minkook Son, Yu-Rin Kim, Hyun-Kyung Kang
Epidemiol Health. 2022;44:e2022077.   Published online September 21, 2022
DOI: https://doi.org/10.4178/epih.e2022077
  • 7,076 View
  • 280 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
We investigated the risk of dementia in older adults with chronic periodontitis according to the severity of periodontitis.
METHODS
Data on patients with chronic periodontitis were extracted from the National Health Insurance Service-Senior cohort database from 2002 to 2014. Among 52,728 subjects eligible for inclusion, 11,953 subjects had newly diagnosed mild chronic periodontitis (MCP), and 40,775 subjects had newly diagnosed severe chronic periodontitis (SCP). Two 1:1 propensity score matched cohorts were created with 8,624 patients each in the MCP and SCP groups. To analyze the risk of dementia, a Cox proportional-hazard model was used to calculate hazard ratios with 95% confidence intervals (CIs).
RESULTS
In the Kaplan-Meier curve, the disease-free probability was significantly lower in the SCP group than in the MCP group (p for log-rank=0.001). In the multivariable-adjusted model, the HR for the occurrence of dementia in the SCP group compared to the MCP group was 1.15 (95% CI, 1.04 to 1.27; p=0.009). A subgroup analysis revealed a significant association between dementia and the severity of periodontitis, especially in subjects who were male, aged ≥70 years, and had comorbidities.
CONCLUSIONS
Reducing the severity of chronic periodontitis can help to reduce the risk of dementia. Therefore, it is necessary to aggressively conduct early dementia-prevention programs for males under the age of 70 that include dental health to prevent the progression of periodontitis from mild to severe.
Summary
Korean summary
본 연구는 만성치주질환을 가진 노인의 만성치주질환 중등도에 따른 치매 발생위험 차이를 분석하였다. 그 결과, 만성치주질환 중등도가 높은 그룹에서 만성치주질환 중등도가 낮은 그룹에 비해 치매 발생위험이 높았으며, 특히, 남성과 70세 이상 그룹에서 유의한 차이가 있었다. 따라서 70세 이하 남성 노인을 대상으로 만성치주질환이 진행되지 않도록 효과적인 구강관리가 필요할 것이다.
Key Message
In this study, we confirmed that the severity of chronic periodontitis is related to the risk of dementia, so efforts for effective oral care will be needed.

Citations

Citations to this article as recorded by  
  • With Teeth, Broken, or Fixed: The Challenges of Linking Periodontitis, Neuroepidemiology, and Biomarkers of Disease
    James M. Noble, Panos N. Papapanou
    Journal of Alzheimer's Disease.2023; 93(3): 991.     CrossRef
  • Periodontal Pathogens and Their Links to Neuroinflammation and Neurodegeneration
    David Visentin, Ivana Gobin, Željka Maglica
    Microorganisms.2023; 11(7): 1832.     CrossRef
  • Association between statin compliance and risk of dementia among patients with chronic periodontitis
    Yu‐Rin Kim, Minkook Son, Seon‐Rye Kim
    Oral Diseases.2023;[Epub]     CrossRef
Characteristics of depressive symptoms in middle-aged family members of dementia patients: 2017 Korea Community Health Survey
Jinbeom Park, Won-Chul Lee, Hyunsuk Jeong, Nayoung Hong, BoYoung Bae, Hyeon Woo Yim
Epidemiol Health. 2020;42:e2020031.   Published online May 15, 2020
DOI: https://doi.org/10.4178/epih.e2020031
  • 12,805 View
  • 245 Download
  • 2 Web of Science
  • 3 Crossref
AbstractAbstract PDFSupplementary Material
Abstract
OBJECTIVES
The characteristics of depressive symptoms in the family members of home-dwelling patients with dementia have not been clearly reported. This study aimed to investigate the characteristics of depressive symptoms in middle-aged family members living with a patient with dementia.
METHODS
This study used the data from the nationwide 2017 Korea Community Health Survey. Among the 228,381 survey participants, 77,276 participants in their 40s and 50s were finally selected for this study. The participants consisted of 760 family members of home-dwelling dementia patients and 76,516 general family members comprising a control group.
RESULTS
The positive rate of Patient Health Questionnaire-9 (PHQ-9)-measured depressive symptoms was significantly higher in the family members of home-dwelling dementia patients (4.4%; control group: 1.9%). After adjusting for potential confounders, the prevalence of PHQ-measured depressive symptoms was 1.72 times (95% confidence interval [CI], 1.03 to 2.85) higher in the family members of home-dwelling dementia patients compared to the control group. The positive rate of depressive symptoms was 2.26 times higher (95% CI, 1.26 to 4.05) in the female middle-aged family members of home-dwelling dementia patients compared to the control group. In addition, those who reported having symptoms almost every day in the PHQ-9 questions had significantly higher positive rates on questions about loss of interest, depression, sleep disturbance, fatigue, poor appetite, and suicidal ideation, and not on questions regarding feelings of worthlessness and psychomotor agitation, compared to the control group.
CONCLUSIONS
Active interventions are needed to relieve depression in the family members of home-dwelling dementia patients.
Summary

Citations

Citations to this article as recorded by  
  • Sleep Quality and Depressive Symptoms in Caregivers of Persons with Dementia: A Systematic Review
    Rayhanah R. Almutairi, Jaclene A. Zauszniewski
    Issues in Mental Health Nursing.2023; 44(6): 538.     CrossRef
  • Depression before and during-COVID-19 by Gender in the Korean Population
    Won-Tae Cha, Hye-Jin Joo, Yu-Shin Park, Eun-Cheol Park, Soo-Young Kim
    International Journal of Environmental Research and Public Health.2022; 19(6): 3477.     CrossRef
  • A Study on Complementary Policy to Enhance the Effectiveness of National Dementia Policy in Terms of Medical Services
    Su Jeong Seong, Kang Joon Lee, Woo Jung Kim, Kiwon Kim, Dong Woo Lee
    Journal of Korean Neuropsychiatric Association.2021; 60(4): 396.     CrossRef
Outbreak of Scabies at Geriatric Long-Term Care Facilities in Korea.
Mo Ran Ki, Hyun Jin Moon, Hyoun Cho
Korean J Epidemiol. 2006;28(1):100-111.
  • 65,535 View
  • 41 Download
AbstractAbstract PDF
Abstract
OBJECTIVES
To investigate an outbreak of scabies that occurred in geriatricfacilities located in Kyounggi-province, Korea, between September 2004 and September 2005.
METHODS
We carried out an epidemiologic investigation on the scabies outbreak. All workers except two were interviewed and the charts of the patients were reviewed.
RESULTS
Among workers, the attack rate was 58.6% (17/29). The rate was 86.0%(37/43) in patients. Secondary cases also occurred among the family members of workers, with a secondary attack rate of 15.8%. The 95% confidence interval was 6%~31.3%. The transmission of scabies began from one index case who had scabies and moved from another facility. She was hospitalized on the 4th floor of this facilitywhere dependent patients resided. After the activities (picnic and yard sale) in May 2005, and the ward rotation of care givers between the 3rd and 4th floor in July 2005, the incidence of scabies increased. The last cases occurred in Sep. 2005.
CONCLUSIONS
This outbreak investigation has importance because it is the first report of ascabies outbreak in geriatric long-term care facilities in Korea. Recently, the reports on a scabies epidemic are increasing with the augmentation of geriatric long-term care facilities. It is important to educate and inform workers and staff in long-term care facilities about scabies and other contagious skin diseases. More facilities for senility and dementia will be opened and we need to lookinto contagious diseases in long-term care facilities.
Summary
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