Documentation of Dementia as a Cause of Death Among Mexican-American Decedents Diagnosed with Dementia

Article type: Research Article

Authors: Downer, Brian^{a; b; *} | Chou, Lin-Na^c | Al Snih, Soham^{a; b} | Barba, Cheyanne^d | Kuo, Yong-Fang^{b; e} | Raji, Mukaila^{b; f} | Markides, Kyriakos S.^{b; c} | Ottenbacher, Kenneth J.^{a; b}

Affiliations: [a] Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA | [b] Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA | [c] Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA | [d] Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA | [e] Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA | [f] Internal Medicine –Geriatrics & Palliative Medicine, University of Texas Medical Branch, Galveston, TX, USA

Correspondence: [*] Correspondence to: Brian Downer, PhD, University of Texas Medical Branch, School of Health Professions 301 University Blvd. Galveston, TX 77555, USA. Tel.: +1 409 747 1634; E-mail: brdowner@utmb.edu.

Abstract: 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 (OR = 0.40, 95% CI = 0.28–0.58), older age at death (OR = 1.18, 95% CI = 1.03–1.36), and longer ADRD duration (OR = 1.08, 95% CI = 1.03–1.14) were associated with ADRD as a cause of death. In the last year of life, any ER admission without a hospitalization (OR = 0.45, 95% CI = 0.22–0.92), more physician visits (OR = 0.96, 95% CI = 0.93–0.98), and seeing a medical specialist (OR = 0.46, 95% CI = 0.29–0.75) 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 (OR = 0.55, 95% CI = 0.36–0.82) and ER admission with a hospitalization (OR = 0.67, 95% CI = 0.48–0.94) 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% CI = 1.37–2.87) 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.

Keywords: Cause of death, health services, hispanic Americans, mortality

DOI: 10.3233/JAD-210361

Journal: Journal of Alzheimer's Disease, vol. 82, no. 4, pp. 1727-1736, 2021