Acute Pancreatitis and the Risk of Dementia in Diabetes: A Nationwide Cohort Study Using Korean Healthcare Claims Database

Article type: Research Article

Authors: Paik, Woo Hyun^{a; 1} | Jang, Dong Kee^{b; 1} | Cho, Soyoung^c | Choi, Jin Ho^{a; d} | Kim, Min Kyu^a | Cho, In Rae^a | Ryu, Ji Kon^a | Kim, Yong-Tae^a | Han, Kyung-Do^{e; *} | Lee, Sang Hyub^{a; *}

Affiliations: [a] Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea | [b] Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea | [c] Department of Neurology, H Plus Yangji Hospital, Seoul, South Korea | [d] Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea | [e] Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea

Correspondence: [*] Correspondence to: Kyung-Do Han, PhD, Department of Statistics and Actuarial Science, Soongsil University, 369 Sangdo-ro, Dongjak-gu, Seoul, 06978, South Korea. Fax: +82 2 823 1746; E-mail: hkd917@naver.com and Sang Hyub Lee, MD, PhD, Professor, Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. Tel.: +82 2 2072 2199; Fax: +82 2 6073 5336; E-mail: racole@wm.edu.

Note: [1] These authors contributed equally to this work.

Abstract: Background:Diabetes is a major risk factor for the development of dementia, which has been proven to be associated with systemic inflammation. Acute pancreatitis, also a local and systemic inflammatory disease, is the most common gastrointestinal disease requiring acute hospitalization. Objective:The effect of acute pancreatitis on dementia was investigated in type 2 diabetic patients. Methods:Data was collected from the Korean National Health Insurance Service. The study sample included type 2 diabetes patients who received general health examination from 2009 to 2012. Cox proportional hazard regression analysis was used to evaluate the association between acute pancreatitis and dementia with adjustment of confounders. Stratified subgroup analysis by age, sex, smoking, alcohol consumption, hypertension, dyslipidemia, and body mass index was conducted. Results:Among the 2,328,671 participants in total, 4,463 patients had a history of acute pancreatitis before the health examination. During a median follow-up of 8.1 (IQR, 6.7–9.0) years, 194,023 participants (8.3%) developed all-cause dementia. Previous history of acute pancreatitis was a significant risk factor for dementia after adjustment of confounding variables (HR 1.39 [95% CI 1.26–1.53]). In the subgroup analysis, patient characteristics such as age under 65 years, male, current smoker, and alcohol consumption were significant risk factors for dementia in patients with a history of acute pancreatitis. Conclusion:The history of acute pancreatitis was associated with the development of dementia in patients with diabetes. Because the risk of dementia increases with alcohol consumption and smoking in diabetic patients with history of acute pancreatitis, abstinence from alcohol and smoking should be recommended.

Keywords: Alzheimer’s disease, big data, dementia, diabetes mellitus, pancreatitis

DOI: 10.3233/JAD-220353

Journal: Journal of Alzheimer's Disease, vol. 94, no. 1, pp. 205-216, 2023