PND49 - Increased Healthcare Utilization in Dementia Subtypes Prior to Diagnosis

Abstract

Health care utilization (HCU) is significantly higher among individuals diagnosed with Alzheimer’s disease and related dementias (ADRD) compared to matched controls. However, few studies have identified comorbidities or services associated with higher HCU, and no study has examined HCU by ADRD subtype. The objectives of this study were to: 1) characterize all-cause and disease-specific health care utilization (HCU) during the three years preceding Alzheimer’s disease and related dementia (ADRD) diagnosis, and 2) determine if HCU increased over time and varied by ADRD subtype. We used data from the OptumLabs™ Data Warehouse to identify individuals diagnosed with ADRD between 2011-2014 and matched controls. ADRD was defined using ICD-9 codes or prescription claims for anti-dementia medications. ADRD subtypes were identified using an algorithm based on ICD-9 codes, prescription claims, temporal sequencing of confirmatory diagnoses, and provider specialty. All-cause and disease-specific HCU was regressed on ADRD subtypes, year, and matching variables. During the three years prior to diagnosis, all cause HCU was significantly higher in cases (n=36,838) than in controls (n=143,413) and varied by ADRD subtype, ranging from a 29% increase among individuals with Alzheimer’s disease to an 86% increase in vascular dementia. HCU among cases was highest for inpatient and long-term care services. There was a significant time effect in all models ranging from a decreasing effect for ancillary services to a large increasing effect for long-term care services. Highest disease-specific HCU was observed for Parkinson’s, psychiatric and chronic liver disease. HCU is significantly higher among individuals with ADRD compared to those without ADRD, even three years before diagnosis, yet variation in HCU by ADRD subtype points to differences in pathways to diagnosis and patterns of use. Better understanding of these pathways will inform novel screening, diagnosis, and treatment interventions that may vary by subtype.