Affiliations: [a] Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| [b] Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| [c] Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| [d] Department of Preventive Medicine, Gachon University College of Medicine, Seoul, Republic of Korea
Correspondence:
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Correspondence to: Jaeyong Shin, MD, MPH, PhD, Department of Preventive Medicine & Institute of Health Services Research, Yonsei University College of Medicine, 50 Yonsei-to, Seodaemun-gu, Seoul 03722, Republic of Korea. Tel.: +82 2 2228 1862; Fax: +82 2 392 8133; E-mail: drshin@yuhs.ac.
Abstract: Background:In aging populations, more elderly patients are going to the intensive care unit (ICU) and surviving. However, the specific factors influencing the occurrence of post-intensive care syndrome in the elderly remain uncertain. Objective:To investigate the association between socioeconomic status (SES) and risk of developing dementia within two years following critical care. Methods:This study included participants from the Korean National Health Insurance Service Cohort Database who had not been diagnosed with dementia and had been hospitalized in the ICU from 2003 to 2019. Dementia was determined using specific diagnostic codes (G30, G31) and prescription of certain medications (rivastigmine, galantamine, memantine, or donepezil). SES was categorized into low (medical aid beneficiaries) and non-low (National Health Insurance) groups. Through a 1:3 propensity score matching based on sex, age, Charlson comorbidity index, and primary diagnosis, the study included 16,780 patients. We used Cox proportional hazard models to estimate adjusted hazard ratios (HR) of dementia. Results:Patients with low SES were higher risk of developing dementia within 2 years after receiving critical care than those who were in non-low SES (HR: 1.23, 95% CI: 1.04–1.46). Specifically, patients with low SES and those in the high-income group exhibited the highest incidence rates of developing dementia within two years after receiving critical care, with rates of 3.61 (95% CI: 3.13–4.17) for low SES and 2.58 (95% CI: 2.20–3.03) for high income, respectively. Conclusions:After discharge from critical care, compared to the non-low SES group, the low SES group was associated with an increased risk of developing dementia.
Keywords: Alzheimer’s disease, critical care, dementia, disparity, post intensive
care syndrome, socioeconomic status
