Marital status associated with excess ADRD mortality among Californians during the COVID‐19 pandemic

Abstract

AbstractBackgroundSocial support shapes the health of older adults with Alzheimer’s disease and related dementias (ADRD), and marital status is linked to ADRD risk and all‐cause mortality. During the Covid‐19 pandemic, older adults with ADRD may have been particularly reliant on key social ties such as spouses. We estimated excess ADRD mortality by marital status among older Californians during the pandemic.MethodUsing California monthly mortality data from January 2016 to February 2020, we built autoregressive integrated moving average time series models to estimate the number of expected deaths with ADRD as a final or contributing cause between March 2020 and December 2022, stratified by marital status and age group. We obtained population estimates from the US Census’ American Community Survey. We calculated cumulative and monthly excess deaths per 100,000 living individuals and relative risk ratios (by dividing the number of observed deaths by the number expected). We simulated models 10,000 times to estimate 95% prediction intervals (PIs) for cumulative measures of excess.ResultAmong older Californians who died with ADRD during the study period, 7% were 65‐74, 26% were 75‐84, and 67% were 85+ (Table 1). Compared to people who were divorced, never married, or widowed, married people experienced the lowest spikes in per capita excess mortality associated with ADRD during the 2020 winter surge, regardless of age group (Figure 1). Among people who were 75 years and older, married people had the fewest estimated cumulative excess deaths per 100,000 population (1385, 95%PI: (1033, 1746)) compared to divorced (3217 (2294, 4155)), never married (2621 (1777, 3471)), and widowed people (2156 (770, 3560) (Table 1), although prediction intervals overlapped.ConclusionBeing married may have protected against excess ADRD mortality during the pandemic among older Californians. The link between marital status and ADRD mortality risk likely reflects several mechanisms: social and emotional support; instrumental support to adhere to safety protocols during contagious outbreaks; caregiving and practical assistance with the activities of daily living; access to a broader social network that may include adult children; and advocacy to ensure appropriate medical care and support.