Incidence and prevalence of dementia in linked administrative health data in Saskatchewan, Canada: a retrospective cohort study

BMC Geriatrics

Jacqueline M. Quail⁶  Anthea Innes⁴  Dorothy A. Forbes⁹  Vanina Dal Bello-Haas⁷  Norma J. Stewart²  Gary F. Teare⁶  Margaret Crossley^1,10  Andrew Kirk¹  Megan E. O’Connell³  Debra G. Morgan⁸  Julie G. Kosteniuk⁵ 

[1]Division of Neurology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada

[2]College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada

[3]Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada

[4]Bournemouth University Dementia Institute, Bournemouth University, Dorset, UK

[5]Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon S7N 2Z4, SK, Canada

[6]Saskatchewan Health Quality Council, Saskatoon, SK, Canada

[7]School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada

[8]Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada

[9]Faculty of Nursing, University of Alberta, Edmonton, AB, Canada

[10]Department of Psychology (Professor Emerita), University of Saskatchewan, Saskatoon, SK, Canada

关键词: Prescription drug;    Long-term care;    Hospital;    Primary care;    Epidemiology;    Incidence;    Prevalence;    Diagnosis;    Alzheimer’s disease;    Dementia;   

Others  :  1218276
DOI  :  10.1186/s12877-015-0075-3

 received in 2014-12-01, accepted in 2015-06-16,  发布年份 2015

【 摘 要 】

Background

Determining the epidemiology of dementia among the population as a whole in specific jurisdictions – including the long-term care population–is essential to providing appropriate care. The objectives of this study were to use linked administrative databases in the province of Saskatchewan to determine the 12-month incidence and prevalence of dementia for the 2012/13 period (1) among individuals aged 45 and older in the province of Saskatchewan, (2) according to age group and sex, and (3) according to diagnosis code and other case definition criteria.

Methods

We used a population-based retrospective cohort study design and extracted data from 10 provincial health databases linked by a unique health services number. The cohort included individuals 45 years and older at first identification of dementia between April 1, 2001 and March 31, 2013 based on case definitions met within any one of four administrative health databases (Hospital Discharge Abstracts, Physician Service Claims, Prescription Drug, and RAI-MDS, i.e., Long-term Care).

Results

A total of 3,270 incident cases of dementia (7.28 per 1,000 PAR) and 13,012 prevalent cases (28.16 per 1,000 PAR) were identified during 2012/13. This study found the incidence rate increased by 2.8 to 5.1 times and the prevalence rate increased by 2.6 to 4.6 times every 10 years after 45 years of age. Overall, the age-standardised incidence rate was significantly lower among females than males (7.04 vs. 7.65 per 1,000 PAR) and the age-standardised prevalence rate was significantly higher among females than males (28.92 vs. 26.53 per 1,000 PAR). Over one-quarter (28 %) of all incident cases were admitted to long-term care before a diagnosis was formally recorded in physician or hospital data, and nearly two-thirds of these cases were identified at admission with impairment at the moderate to very severe level or a disease category of Alzheimer’s disease/other dementia.

Conclusions

Linking multiple sources of registry data contributes to our understanding of the epidemiology of dementia across multiple segments of the population, inclusive of individuals residing in long-term care. This information is foundational for public awareness and policy recommendations, health promotion and prevention strategies, appropriate health resource planning, and research priorities.

【 授权许可】

   
2015 Kosteniuk et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]World Health Organization and Alzheimer’s Disease International. Dementia: A Public Health Priority. 2012.. http://www.who.int/mental_health/publications/dementia_report_2012/en/ webcite
• [2]Prince M, Guerchet M, Prina M, Alzheimer’s Disease International. Policy Brief for Heads of Government: The Global Impact of Dementia 2013–2050; 2013.. http://www.alz.co.uk/research/G8-policy-brief webcite
• [3]United Nations, Department of Economic and Social Affairs, Population Division: World Population Ageing 2013. ST/ESA/SER.A/348. 2013.
• [4]World Health Organization and US National Institute on Aging. Global Health and Aging; 2011.. http://www.who.int/ageing/publications/global_health/en/ webcite
• [5]United Kingdom Department of Health and Prime Minister’s Office, 10 Downing Street. G8 Dementia Summit Communique; 2013.. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/265868/2901669_G8_DementiaSummitCommunique_acc.pdf webcite
• [6]Alzheimer’s Disease International. National Alzheimer and Dementia Plans Planned Policies and Activities; 2012.. http://www.alz.co.uk/alzheimer-plans webcite
• [7]Alzheimer’s Disease International. World Alzheimer Report 2011: The Benefits of Early Diagnosis and Intervention; 2011.. http://www.alz.co.uk/research/world-report-2011 webcite
• [8]Alzheimer’s Disease International. World Alzheimer Report 2012: Overcoming the Stigma of Dementia; 2012.. http://www.alz.org/documents_custom/world_report_2012_final.pdf webcite
• [9]Boustani M, Peterson B, Hanson L, Harris R, Lohr K: Screening for dementia in primary care: A summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2003, 138:927-937.
• [10]Bradford A, Kunik M, Schulz P, Williams S, Singh H: Missed and delayed diagnosis of dementia in primary care: prevalence and contributing factors. Alzheimer Dis Assoc Disord 2009, 23(4):306-314.
• [11]Van den Dungen P, Van Marwijk H, Van der Horst H, Moll Van Charante E, MacNeil Vroomen J, Van de Ven P, van Jout H: The accuracy of family physicians’ dementia diagnoses at different stages of dementia: A systematic review. Int J Geriatr Psychiatry 2012, 27:342-354.
• [12]Sternberg S, Wolfson C, Baumgarten M: Undetected dementia in community-dwelling older people: The Canadian Study of Health and Aging. J Am Geriatr Soc 2000, 48(11):1430-1434.
• [13]Iliffe S, Manthorpe J, Eden A: Sooner or later? Issues in the early diagnosis of dementia in general practice. Fam Pract 2003, 20(4):376-381.
• [14]Koch T, Iliffe S: The role of primary care in the recognition of and response to dementia. J Nutr Health Aging 2010, 11:52.
• [15]Herrera E, Caramelli P, Silveira A, Nitrini R: Epidemiologic survey of dementia in a community-dwelling Brazilian population. Alzheimer Dis Assoc Disord 2002, 16(2):103-108.
• [16]Shaji S, Bose S, Verghese A: Prevalence of dementia in an urban population in Kerala, India. Br J Psychiatry 2005, 186:136-140.
• [17]Rodriguez J, Ferri C, Acosta D, Guerra M, Huang Y, Jacob K, Krishnamoorthy E, Salas A, Sosa A, Acosta I, Dewey M, Gaona C, Jotheeswaran A, Li S, Rodriguez D, Rodriguez G, Kumar P, Valhuerdi A, Prince M: 10/66 Dementia Research Group: Prevalence of dementia in Latin America, India, and China: A population-based cross-sectional survey. Lancet 2008, 372(9637):464-474.
• [18]Thies W, Bleiler L: Alzheimer’s disease facts and figures. Alzheimers Dement 2013, 2013(9):208-245.
• [19]Berr C, Wancata J, Ritchie K: Prevalence of dementia in the elderly in Europe. Eur Neuropsychopharmacology 2005, 15:463-471.
• [20]Canadian Study of Health and Aging Working Group: The incidence of dementia in Canada Neurology 2000, 55(1):66-73.
• [21]Ducharme F, Kergoat MJ, Antoine P, Pasquier F, Coulombe R: Caring for individuals with early-onset dementia and their family caregivers: the perspective of health care professionals. Adv Alzheimers Dis 2014, 3:33-43.
• [22]Danila O, Hirdes J, Maxwell C, Marrie R, Patten S, Pringsheim T: Prevalence of neurological conditions across the continuum of care based on interRAI assessments. BMC Health Serv Res 2014, 14:29. BioMed Central Full Text
• [23]Myers R, Shaheen A, Fong A, Burak K, Wan A, Swain M, Hilsden R, Sutherland L, Quan H: Epidemiology and natural history of primary biliary cirrhosis in a Canadian health region: A population-based study. Hepatology 2009, 50:1884-1892.
• [24]Saskatchewan Bureau of Statistics. Saskatchewan Population by 5 Year Age Groups, 2003 to 2013; 2014.. http://www.stats.gov.sk.ca/pop/ webcite
• [25]Statistics Canada. Annual Demographic Estimates: Subprovincial Areas (Cat. no. 91-214-X). Ottawa: Statistics Canada; 2014.. http://www.statcan.gc.ca/pub/91-214-x/91-214-x2012000-eng.pdf webcite
• [26]Statistics Canada. Annual Demographic Estimates: Canada, Provinces, and Territories (Cat. no. 91-215-X). Ottawa: Statistics Canada; 2014.. http://www.statcan.gc.ca/pub/91-215-x/2012000/t583-eng.htm webcite
• [27]Health Canada. Canada’s Health Care System; 2011.. http://www.hc-sc.gc.ca/hcs-sss/pubs/system-regime/2011-hcs-sss/index-eng.php webcite
• [28]Saskatchewan Ministry of Health. Fully Covered Services; 2012.. https://www.saskatchewan.ca/live/health-and-healthy-living/health-benefits-and-prescription-drug-plans/universal-benefits/fully-covered-services webcite
• [29]Saskatchewan Ministry of Health. Covered Population 2012; 2012.. http://www.ehealthsask.ca/HealthRegistries/Pages/Covered-Population.aspx webcite
• [30]Saskatchewan Ministry of Health. Health Services Databases: Information Document. Regina, SK: Epidemiology & Research Unit, Population Health Branch; 2010.
• [31]Lix L, Walker R, Quan H, Nesdole R, Yang Y, Chen G: Features of physician services databases in Canada. Chronic Dis Inj Can 2012, 32(4):186-193.
• [32]Aboriginal Affairs and Northern Development Canada. Registered Indian Population by Sex and Residence 2012; 2013.. https://www.aadnc-aandc.gc.ca/eng/1373985023065/1373985196078 webcite
• [33]Morris JN, Hawes C, Mor V, Phillipo C, Frieo BE, Nonemaker S, Murphy K: Resident Assessment Instrument (RAI) RAI-MDS 2.0 User’s Manual. Canadian Version. Canadian Institute for Health Information, Canada; 2010.
• [34]Poss J, Jutan N, Hirdes J, Fries B, Morris JN, Teare G, Reidel K: A review of evidence on the reliability and validity of Minimum Data Set data. Healthc Manage Forum 2008, 21(1):33-39.
• [35]Wodchis W, Naglie G, Teare G: Validating diagnostic information on the Minimum Data Set in Ontario hospital-based long-term care. Med Care 2008, 46(8):882-887.
• [36]Hirdes JP, Poss JW, Caldarelli H, Fries BE, Morris JN, Teare GF, Reidel K, Jutan N: An evaluation of data quality in Canada’s Continuing Care Reporting System (CCRS): Secondary analyses of Ontario data submitted between 1996 to 2011. BMC Med Inform Decis Mak 2013, 13:27. BioMed Central Full Text
• [37]Morris J, Fries B, Mehr D, Hawes C, Phillips C, Mor V, Lipsitz L: MDS Cognitive Performance Scale. J Gerontol 1994, 49(4):M174-M182.
• [38]Manitoba Centre for Health Policy MCHP. Dementia Concept Description; 2012.. http://mchp-appserv.cpe.umanitoba.ca/viewConcept.php?conceptID=1179 webcite
• [39]Chartier M, Finlayson G, Prior H, McGowan K, Chen H, de Rocquigny J, Walld R, Gousseau M: Health and Healthcare Utilization of Francophones in Manitoba. Winnipeg, MB. Manitoba Centre for Health Policy; 2012.
• [40]Martens P, Bartlett J, Burland E, Prior H, Burchill C, Huq S, Romphf L, Sanguins J, Carter S, Bailly A: Profile of Metis Health Status and Healthcare Utilization in Manitoba: A Population-Based Study. Winnipeg, MB, Manitoba Centre for Health Policy; 2010.
• [41]Fransoo R, Martens P, Burland E, Prior H, Burchill C: The Need to Know Team: Manitoba RHA Indicators Atlas 2009 . Manitoba Centre for Health Policy, Winnipeg, MB; 2009.
• [42]Gill S, Camacho X, Poss J. Community-dwelling older adults with dementia: tracking encounters with the health system. In: Bronskill S, Camacho X, Gruneir A, Ho M. editors. Health System Use by Frail Ontario Seniors: An In-Depth Examination of Four Vulnerable Cohorts. Toronto, ON: Institute for Clinical Evaluative Sciences; 2011.. http://www.ices.on.ca/Publications/Atlases-and-Reports/2011/Health-System-Use webcite
• [43]Jacklin K, Walker J, Shawande M: The emergence of dementia as a health concern among first nations populations in Alberta, Canada. Can J Public Health 2013, 104(1):e39-e44.
• [44]Jacklin K, Walker J: Trends in Alzheimer’s Disease and Related Dementias among First Nations and Inuit: Final Report. Prepared for Health Canada, First Nations, and Inuit Health, Home and Community Care Program 2012.
• [45]Connolly A, Gaehl , Martin H, Morris J, Purandare N: Underdiagnosis of dementia in primary care: variations in the observed prevalence and comparisons to the expected prevalence. Aging Ment Health 2011, 15(8):978-984.
• [46]St Germaine-Smith C, Metcalfe A, Pringsheim T, Roberts J, Beck C, Hemmelgarn B, McChesney J, Quan H, Jette N: Recommendations for optimal ICD codes to study neurologic conditions: A systematic review. Neurology 2012, 79:1049-1055.
• [47]Lee P, Hsiung G, Seitz D, Gill S, Rochon P: Cholinesterase inhibitors. BC Med J 2011, 53(8):404-408.
• [48]Birks J: Cholinesterase Inhibitors for Alzheimer’s Disease. Cochrane Libr 2006, 1:1-98.
• [49]Bartfay E, Bartfay W, Gorey K: Prevalence and correlates of potentially undetected dementia among residents of institutional care facilities in Ontario, Canada, 2009–2011. Int J Geriatr Psychiatry 2013, 28:1086-1094.
• [50]Perneczky R, Wagenpfeil S, Komossa K, Grimmer T, Diehl J, Kurz A: Mapping scores onto stages: Mini-Mental State Examination and Clinic Dementia Rating. Am J Geriatr Psychiatry 2006, 14(2):139-144.
• [51]Travers C, Byrne G, Pachana N, Klein K, Gray L: Validation of the Interrai Cognitive Performance Scale against independent clinical diagnosis and the Mini-Mental State Examination in older hospitalized patients. J Nutr Health Aging 2013, 17:435-439.
• [52]Paquay L, De Lepeleire J, Schoenmakers B, Ylieff M, Fontaine O, Buntinx : Comparison of the diagnostic accuracy of the Cognitive Performance Scale (Minimum Data Set) and the Mini-Mental State Exam for the detection of cognitive impairment in nursing home residents. Int J Geriatr Psychiatry 2007, 22:286-293.
• [53]Canadian Study of Health & Aging Working Group: Canadian Study of Health & Aging: Study methods and prevalence of dementia Can Med Assoc J 1994, 150:899-913.
• [54]Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri C: The global prevalence of dementia: A systematic review and metaanalysis. Alzheimers Dement 2013, 9:63-75.
• [55]World Health Organization. World Health Statistics 2014; 2014.. http://apps.who.int/iris/bitstream/10665/112738/1/9789240692671_eng.pdf webcite
• [56]Lambert M, Bickel H, Prince M, Fratiglioni L, Bon Strauss E, Frydecka D, Kiejna A, Georges J, Reynish E: Estimating the burden of early onset dementia: systematic review of disease prevalence. Eur J Neurology 2014, 21(4):563-569.
• [57]Jellinger K: Clinicopathological analysis of dementia disorders in the elderly – an update. J Alzheimers Dis 2006, 9(Suppl):61-70.