Mortality Rate of Individuals With Alzheimer Disease, Dementias Increased During COVID-19 Pandemic

During the height of the COVID-19 pandemic from March 2020 to February 2021, the mortality rate of individuals with Alzheimer disease and related dementias (ADRD) increased according to new study findings published in Jama Network.

Grandmother in isolation during a coronavirus pandemic | Image credit: Pikselstock - stock.adobe.com

“Tracking excess mortality associated with ADRD over the pandemic is critical to inform policy and research priorities, as changes in mortality provide insights into whether current preventive measures are effective at protecting older adults with ADRD,” said the study authors.

According to the study, this analysis was conducted to compare pandemic-era deaths related to ADRD between year 1 and year 2 of the COVID-19 pandemic. The researchers analyzed age, sex, race, ethnicity, and place of death. Death certificate data from January 2014 to December 2021 along with provisional death certificate data from January 2022 to February 2022 were accessed from the National Center for Health Statistics Mortality Surveillance System.

“We considered deaths with any mention of ADRD on the death certificate, including as the underlying cause or any of up to 19 listed contributing conditions as deaths with ADRD. ADRD was classified by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes and included unspecified dementia, Alzheimer disease, vascular dementia, and other degenerative diseases of the nervous system,” said the study authors.

According to the study, the researchers analyzed 2,234,101 death certificates of individuals who were aged 65 years and older. Using data from the US Census Bureau Populations Estimates program, they were able to find state-specific population estimates, age, race and ethnicity, and sex of each of the individuals. The ages were grouped into 65 to 74 and 75 to 85 years of age. Race and ethnicity were classified as Hispanic; non-Hispanic; Asian or Pacific Islander; non-Hispanic Black; and non-Hispanic White. The places of death were in medical facilities (including inpatient, outpatient, emergency department, dead on arrival); decedent’s home; nursing home or long-term care; or hospice facility.

The results from this analysis showed that in year 1 of the COVID-19 pandemic, 94,688 deaths were caused by COVID-19 in individuals with ADRD. However, in year 2, that number decreased to 21,586 deaths.

The analysis confirmed that pandemic-related deaths in nursing homes and long-term care facilities went from 34,259 in year 1 and decreased to 13,273 in year 2. The rate of deaths that took place in homes remained high from year 1 to year 2, going from 34,487 to 28,804.

According to the study, in year 1, Black older individuals with ADRD experienced more excess deaths in the beginning of the pandemic. The study said that due to the racial segregation of nursing home facilities, Black individuals were more likely to be clustered in areas with worse infection rates.

“Discrimination in medical settings and differential prevalence of comorbidities may also have contributed to this excess mortality. Racial and ethnic disparities in excess ADRD-related deaths persisted despite declines in ADRD-related deaths across all racial and ethnic groups in year 2. These findings highlight the need to monitor inequalities and attend to how structural racism can exacerbate vulnerability to ADRD-related and COVID-19 mortality,” said the study authors.

The study said that after the COVID-19 vaccine began to be distributed, ADRD-related deaths in health care facilities declined but increased during subsequent new waves. Evaluating the deaths between year 1 and year 2 gave investigators insight as to whether the vaccine or treatment developments added to the decrease in the morality rate for individuals with ADRD.

The findings suggest that individuals with ADRD were at risk during year 1 of the pandemic as mortality rates were high, especially in nursing home and care facilities. Availability of vaccines showed improvement, but mortality rates for ADRD individuals who died in their home was still high in year 2. The research narrowed down the most at-risk populations and potential strategies to mitigate the impacts on adults with ADRD.

References:

Excess Mortality With Alzheimer Disease and Related Dementias as an Underlying or Contributing Cause During the COVID-19 Pandemic in the US. Jama Network. Study Article. July 17, 2023. Accessed July 20, 2023. https://jamanetwork.com/journals/jamaneurology/fullarticle/2806770?guestAccessKey=92347e2b-9efc-44bb-a012-04f5b6b00195&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=071723.