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Original article Overall and cause-specific mortality in patients with dementia: a population-based cohort study in Taiwan
Chia-Lun Kuo1,2orcid , Pei-Chen Lee1orcid , Li-Jung Elizabeth Ku1orcid , Yu Sun3,4orcid , Tsung-Hsueh Lu1orcid , Muhammad Atoillah Isfandiari5orcid , Chung-Yi Li1,5orcid
Epidemiol Health 2023;e2023082
DOI: https://doi.org/10.4178/epih.e2023082 [Accepted]
Published online: August 31, 2023
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1Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
2Department of Psychiatry, Taso-Tun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan
3Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan
4Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
5Division of Epidemiology, Department of Epidemiology, Biostatistics and Demography, Health Promotion and Behavioral Science Faculty of Public Health, Surabaya, Indonesia
6Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
7Department of Healthcare Administration College of Medical and Health Science, Asia University, Taichung, Taiwan
Corresponding author:  Chung-Yi Li,
Email: cyli99@mail.ncku.edu.tw
Received: 7 February 2023   • Revised: 11 August 2023   • Accepted: 11 August 2023
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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 25.99% of total deaths (n=3,505), followed by respiratory disease at 21.32% (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.

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