Nationwide Inpatient Prevalence, Predictors, and Outcomes of Alzheimer’s Disease among Older Adults in the United States, 2002–2012

Article type: Research Article

Authors: Beydoun, May A.^{a; *} | Beydoun, Hind A.^b | Gamaldo, Alyssa A.^a | Rostant, Ola S.^a | Dore, Greg A.^a | Zonderman, Alan B.^{a; 1} | Eid, Shaker M.^{c; 1}

Affiliations: [a] National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA | [b] Graduate Program in Public Health, Eastern Virginia Medical School, Norfolk, VA, USA | [c] Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

Correspondence: [*] Correspondence to: May A. Beydoun, PhD, NIH Biomedical Research Center, National Institute on Aging, IRP, 251 Bayview Blvd., Suite 100, Room #:04B118, Baltimore, MD 21224, USA. Fax: +1 410 558 8236; baydounm@mail.nih.gov

Note: [1] Co-senior authors.

Abstract: In the inpatient setting, prevalence, predictors, and outcomes [mortality risk (MR), length of stay (LOS), and total charges (TC)] of Alzheimer’s disease (AD) are largely unknown. We used data on older adults (60+ y) from the Nationwide Inpatient Sample (NIS) 2002–2012. AD prevalence was ∼3.12% in 2012 (total weighted discharges with AD ± standard error: 474, 410 ± 6,276). Co-morbidities prevailing more in AD inpatient admissions included depression (OR = 1.67, 95% CI: 1.63–1.71, p <  0.001), fluid/electrolyte disorders (OR = 1.25, 95% CI: 1.22–1.27, p <  0.001), weight loss (OR = 1.26, 95% CI: 1.22–1.30, p <  0.001), and psychosis (OR = 2.59, 95% CI: 2.47–2.71, p <  0.001), with mean total co-morbidities increasing over time. AD was linked to higher MR and longer LOS, but lower TC. TC rose in AD, while MR and LOS dropped markedly over time. In AD, co-morbidities predicting simultaneously higher MR, TC, and LOS (2012) included congestive heart failure, chronic pulmonary disease, coagulopathy, fluid/electrolyte disorders, metastatic cancer, paralysis, pulmonary circulatory disorders, and weight loss. In sum, co-morbidities and TC increased over time in AD, while MR and LOS dropped. Few co-morbidities predicted occurrence of AD or adverse outcomes in AD.

Keywords: Alzheimer’s disease, co-morbidity, health care cost, inpatient sample, length of stay, mortality, older adults

DOI: 10.3233/JAD-150228

Journal: Journal of Alzheimer's Disease, vol. 48, no. 2, pp. 361-375, 2015