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COVID‐19 hospitalization and mortality in community‐dwelling racially and ethnically diverse persons living with dementia.
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- Author(s): Thunell, Johanna A.; Ferido, Patricia; Zissimopoulos, Julie M.
- Source:
Journal of the American Geriatrics Society. May2023, Vol. 71 Issue 5, p1429-1439. 11p. - Source:
- Additional Information
- Subject Terms: FEE for service (Medical fees); COVID-19; CONFIDENCE intervals; MULTIVARIATE analysis; RACE; RETROSPECTIVE studies; DEMENTIA patients; HOSPITAL care of older people; INDEPENDENT living; DEMENTIA; PSYCHOSOCIAL factors; DESCRIPTIVE statistics; RESEARCH funding; ETHNIC groups; HEALTH equity; LOGISTIC regression analysis; ODDS ratio; LONGITUDINAL method; MEDICARE
- Abstract: Background: Community‐dwelling persons living with dementia (PLWD) are vulnerable to COVID‐19 infection, severity, and mortality due to the high prevalence of comorbidities, reliance on caregivers, and potential inability to employ risk reduction measures, among other factors. Methods: We used a retrospective cohort of Medicare Fee‐For‐Service beneficiaries enrolled from January 2018 to September 2020 (n = 13,068,583), a comparison cohort from January 2019 to April 2021 (n = 13,250,297), and logistic regression to estimate the effect of dementia on COVID‐19 hospitalization and mortality in community‐dwelling older persons. Results: COVID‐19 diagnoses were higher among persons living with dementia (PLWD) than those without dementia. Conditional on COVID‐19 in the 2020 cohort, White PLWD were at higher risk of hospitalization compared to White persons without dementia (aOR 1.31, 95% CI: 1.26–1.36) and marginal for Black PLWD (aOR 1.10, 95% CI: 1.01–1.20), no significant differences were found within other racial/ethnic groups. PLWD were 1.8 times (aOR 1.78, 95% CI: 1.72–1.84) more likely to die within 30 days of COVID‐19 on average. Within racial/ethnic groups, the estimate for White PLWD, compared with White persons without dementia, was highest (aOR 2.01, 95% CI: 1.92–2.10), followed by Black PLWD (aOR 1.55, 95% CI: 1.41–1.70), and smallest among Hispanic PLWD (aOR 1.37, 95% CI: 1.24–1.50). PLWD hospitalized with COVID‐19 were 1.6 times (aOR 1.59, 95% CI: 1.52–1.67) more likely to die within 30 days than similar persons without dementia. Estimates from the 2021 cohort, when vaccines were available to older persons, were similar to those in 2020. Conclusions: Community‐dwelling PLWD experienced worse outcomes after a COVID‐19 diagnosis than their counterparts without dementia. Results demonstrating higher mortality, but not hospitalization rates, for all races/ethnicities except White PLWD suggest there may have been differential care/treatment that point to potential health care system inequities that persisted into 2021. Understanding the mechanisms underlying these differences may improve ongoing care for community‐dwelling PLWD. [ABSTRACT FROM AUTHOR]
- Abstract: Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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