TOPLINE:

Men with dementia had a 24% higher risk for mortality and a higher use of many healthcare services, particularly hospital stays than women with the condition in a new cohort study.

METHODOLOGY:

• The retrospective cohort study included more than 5.7 million US Medicare fee-for-service beneficiaries aged 65 years or older with incident dementia analyzed between 2013 and 2021, with up to 8 years of follow-up.
• Dementia was identified in participants (58% women) enrolled in Medicare at least 1 year prior using diagnostic codes from such manuals as the International Classification of Diseases, Ninth Revision.
• The primary outcome was all-cause mortality; secondary outcomes included use of healthcare services.
• Analysis adjusters included demographic factors, comorbid medical conditions, and availability of county-level healthcare resources

TAKEAWAY:

• Women with dementia had lower crude mortality rates at 1 year than men (22% vs 27%, respectively) and lower all-cause hospitalization rates (47% vs 51%; P < .001 for both).
• In unadjusted analyses, men with dementia had an increased risk for death at 1 year compared with women (hazard ratio [HR], 1.30; P < .001), as well as increased risk for all-cause hospitalization (HR, 1.13), hospice stay (HR, 1.09), hospitalization for neurodegenerative diagnosis or behavioral disturbance (HR, 1.24), neuroimaging services (HR, 1.08), and receipt of physical or occupational therapy (HR, 1.07; P < .001 for all comparisons). However, they had a lower risk for skilled nursing facility stays (HR, 0.97; P < .001).
• After full adjustment, men still had higher rates of mortality (adjusted HR [aHR], 1.24), all-cause hospitalization and hospice stay (aHR, 1.08 for both), hospitalization for neurodegenerative diagnosis or behavioral disturbance (aHR, 1.46), and receipt of neuroimaging services (aHR, 1.04; P < .001 for all).
• Men with dementia also spent fewer days in both hospice and skilled nursing settings than women (risk ratio [RR], 0.92; P < .001, and RR, 0.97; P = .01, respectively).

IN PRACTICE:

“Strategies to slow mortality and decrease healthcare use among male patients with dementia may be particularly impactful in limiting the burden of dementia. Given higher incidence of dementia among women, a focus on efforts to prevent dementia is necessary to achieve population-level health equity in dementia-attributable mortality by sex,” the investigators of the study wrote.

SOURCE:

The study was led by Jay B. Lusk, MD, Duke University School of Medicine, Durham, North Carolina. It was published online on August 11 in JAMA Neurology.

LIMITATIONS:

The study was restricted to fee-for-service Medicare beneficiaries in the US, potentially limiting generalizability to other populations or healthcare systems. The use of diagnosis codes for identifying dementia cases may have led to misclassification, and the researchers were unable to explore whether sex differences in mortality varied across different dementia syndromes. Additional limitations included unmeasured confounding from comorbid illnesses not captured in the structured claims data, reliance on Social Security sex classifications that did not reflect gender identity, the possibility that the COVID-19 pandemic led to excess mortality among patients with dementia, and the observational design of the study, which prevented the establishment of causality.

DISCLOSURES:

The study was funded by Duke University Department of Neurology and Duke University Health System. Several investigators reported having financial and other ties with various sources. Full details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.