Use of medical care in the 7 years before dementia in the French health insurance database in 2016

Abstract

Abstract Background The entry into dementia is a period of growing interest for clinical trials and public health policies. We described the frequency of medical care use in the 7 years prior to the first dementia identification (index date). Methods All French health insurance general scheme beneficiaries aged 65 or more with an incident dementia in 2016 (identified through long-term disease registry, hospitalization diagnoses, or specific drug delivery), were matched with beneficiaries without dementia of same age, gender, area of residence. The annual cumulative incidences (ACI) of visits (GP and specialists, including outpatient hospital visits) and hospitalizations were estimated over 7 years (Y-7 to Y-1 before index date), by age (65-74, 75-84, 85-89, 90+). Results Among 274166 subjects (median age 84, 65% women), the ACI of GP visit was stable and similar between cases and controls, around 95%. The ACI of neurologist, psychiatrist and internist visit and of hospitalization in a psychiatric unit increased in cases, especially in Y-1. They were higher than in controls in the youngest age classes. The ACI of visits to a dermatologist, a rheumatologist, an ophthalmologist, a dentist and for women a gynecologist, were lower in cases than in controls, with an increasing difference in the last years before dementia care. Similar patterns were observed in the oldest exclusively (generally ≥85 yo) for pneumologist, cardiologist, nephrologist, and in a lesser extent, endocrinologist visit. The ACI of hospitalizations increased with time in both groups, with a peak in Y-1 in cases. They were higher in cases than in controls in the youngest age classes. Conclusions The increase in hospitalization rate in Y-1 suggests a decline in clinical status leading to the diagnosis or a weakening at the time of entry into dementia. The lesser use of a specialist other than neurologist or psychiatrist suggests a focus of care around dementia, possibly to the detriment of the care of comorbidities. Key messages As most patients visit their GP at least yearly, specific GPs training could help to make a timely diagnosis of major neurocognitive disorders. The lesser use of a specialist other than neurologist or psychiatrist suggests a focus of care around dementia, possibly to the detriment of the care of comorbidities.