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- Title
Excess Mortality With Alzheimer Disease and Related Dementias as an Underlying or Contributing Cause During the COVID-19 Pandemic in the US.
- Authors
Chen, Ruijia; Charpignon, Marie-Laure; Raquib, Rafeya V.; Wang, Jingxuan; Meza, Erika; Aschmann, Hélène E.; DeVost, Michelle A.; Mooney, Alyssa; Bibbins-Domingo, Kirsten; Riley, Alicia R.; Kiang, Mathew V.; Chen, Yea-Hung; Stokes, Andrew C.; Glymour, M. Maria
- Abstract
This cross-sectional study compares COVID-19 pandemic-era excess deaths associated with Alzheimer disease or related dementias between year 1 and year 2 overall and by age, sex, race and ethnicity, and place of death. Key Points: Question: How did mortality with Alzheimer disease and related dementias (ADRD) as an underlying or contributing cause change during the COVID-19 pandemic? Findings: This cross-sectional study found a large increase in ADRD-related mortality during pandemic year 1 (March 2020 to February 2021) compared with prepandemic mortality rates but substantial declines from year 1 to year 2 (March 2021 to February 2022). The largest declines occurred in nursing home/long-term care settings, but excess mortality occurring at home and medical facilities remained high in year 2. Meaning: Major reductions in pandemic-era ADRD-related excess mortality were achieved in pandemic year 2 for nursing home/long-term care settings residents. Importance: Adults with Alzheimer disease and related dementias (ADRD) are particularly vulnerable to the direct and indirect effects of the COVID-19 pandemic. Deaths associated with ADRD increased substantially in pandemic year 1. It is unclear whether mortality associated with ADRD declined when better prevention strategies, testing, and vaccines became widely available in year 2. Objective: To compare pandemic-era excess deaths associated with ADRD between year 1 and year 2 overall and by age, sex, race and ethnicity, and place of death. Design, Setting, and Participants: This time series analysis used all death certificates of US decedents 65 years and older with ADRD as an underlying or contributing cause of death from January 2014 through February 2022. Exposure: COVID-19 pandemic era. Main Outcomes and Measures: Pandemic-era excess deaths associated with ADRD were defined as the difference between deaths with ADRD as an underlying or contributing cause observed from March 2020 to February 2021 (year 1) and March 2021 to February 2022 (year 2) compared with expected deaths during this period. Expected deaths were estimated using data from January 2014 to February 2020 fitted with autoregressive integrated moving average models. Results: Overall, 2 334 101 death certificates were analyzed. A total of 94 688 (95% prediction interval [PI], 84 192-104 890) pandemic-era excess deaths with ADRD were estimated in year 1 and 21 586 (95% PI, 10 631-32 450) in year 2. Declines in ADRD-related deaths in year 2 were substantial for every age, sex, and racial and ethnic group evaluated. Pandemic-era ADRD-related excess deaths declined among nursing home/long-term care residents (from 34 259 [95% PI, 25 819-42 677] in year 1 to −22 050 [95% PI, −30 765 to −13 273] in year 2), but excess deaths at home remained high (from 34 487 [95% PI, 32 815-36 142] in year 1 to 28 804 [95% PI, 27 067-30 571] in year 2). Conclusions and Relevance: This study found that large increases in mortality with ADRD as an underlying or contributing cause of death occurred in COVID-19 pandemic year 1 but were largely mitigated in pandemic year 2. The most pronounced declines were observed for deaths in nursing home/long-term care settings. Conversely, excess deaths at home and in medical facilities remained high in year 2.
- Publication
JAMA Neurology, 2023, Vol 80, Issue 9, p919
- ISSN
2168-6149
- Publication type
Article
- DOI
10.1001/jamaneurol.2023.2226