Economic status and mortality in Alzheimer's disease patients in Japan: LIFE Study

Abstract

AbstractBackgroundAlzheimer's disease (AD) is an urgent global health priority, with a projected 75 million cases by 2030 and 131 million cases by 2050 worldwide. Low economic status in patients may affect prognoses by limiting the opportunities to receive appropriate care. However, the association between economic status and mortality among AD patients in Japan is unclear. This study sought to examine the influence of economic status on mortality in individuals with AD in Japan.MethodClaims data from April 2014 to March 2019 were obtained from the Longevity Improvement & Fair Evidence Study (LIFE Study) database, which contains municipality‐level information. The study subjects were individuals residing in one rural city who received new diagnoses of AD in October 2014 or later. To analyze economic status, we examined the utilization of a program designed to reduce the maximum healthcare expenditures for low‐income individuals. Subjects who were enrolled in this program upon receiving a new AD diagnosis were designated low‐income individuals. All subjects were tracked for a maximum of 54 months following AD diagnosis, and the number of months before a mortality event was assessed. The hazard ratio (HR) for mortality in low‐income individuals was estimated using a Cox proportional hazards model that adjusted for sex, age, Charlson comorbidity index, healthcare expenditures in the 6 months before AD diagnosis, and anti‐dementia drug use.ResultWe identified 1,571 newly diagnosed AD patients from the LIFE Study database. The mean age was 83.6 years, 68.1% were women, and 17.5% were low‐income individuals. With a mean follow‐up period of 24.8 months, the mortality rate was 21.3% (334 subjects). The survival rates were 88.7% and 75.0% after 12 and 36 months of follow‐up, respectively. The HR (95% confidence interval) for mortality was 2.18 (1.69‐2.80) for low‐income individuals and 2.15 (1.71‐2.72) for men.ConclusionLow‐income status was associated with substantially poorer prognoses in new AD cases. These findings indicate a need for a thorough examination of the medical and nursing care services utilized by low‐income individuals with AD, and for an exploration of improvement strategies.