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Estimates of the association of dementia with US mortality levels using linked survey and mortality records

JAMA Aug 27, 2020

Stokes AC, Weiss J, Lundberg DJ, et al. - Researchers sought to investigate the correlation of dementia and cognitive impairment without dementia (CIND) with all-cause mortality. They used nationally representative survey data with validated measures of cognitive status from the Health and Retirement Study, which was linked cause-of-death records, to include 7,342 older adults in this study. Between 2000 and 2009, the percentage of deaths attributable to dementia was 13.6%. Non-Hispanic Black participants had a significantly higher mortality burden of dementia vs non-Hispanic White participants; adults with less than a high school education also had a significantly higher mortality burden of dementia vs those with a college education. The contribution of dementia to US mortality was underestimated by a factor of 2.7 when looking at the underlying cause of death recorded on death certificates. The disparity between the population-attributable fraction and the underlying cause of death estimate increased to a factor of 4.8 when considering deaths attributable to CIND as well. The results of this study suggest that dementia could be a more significant factor in US mortality than the routine mortality statistics indicate, illustrating the need to expand population-based interventions focused on prevention and care for dementia.

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