Association of multiple long-term conditions with healthcare utilization and mortality in people living with dementia : evidence from real-world data

Abstract

With population ageing and increased life expectancy, the prevalence of dementia has risen significantly worldwide. People living with dementia often have multiple long-term conditions, and their co-existence with dementia not only increases the burden on the patients and their caregivers but also brings tremendous challenges for the healthcare system. Understanding how multiple long-term conditions affect public healthcare resource utilization, potentially preventable readmissions, and mortality is important for improving people’s health outcomes and optimizing public medical resource allocation. However, there is limited research in this field, especially in Chinese societies that have the largest number of people living with dementia in the world. This research comprehensively investigated the association of multiple long-term conditions with healthcare utilization and mortality in this vulnerable population using territory-wide electronic medical records of people with a dementia diagnosis in Hong Kong. The first study investigated the association between multiple long-term conditions and healthcare utilization amongst individuals living with dementia diagnosis records between 2010 and 2019 and found that the prevalence of multiple long-term conditions in addition to dementia was 81.2%, and healthcare utilization increased monotonically with the number of conditions. Additionally, patients with chronic kidney diseases had the highest risk of hospitalization (RR 1.81 [95% CI 1.74-1.89]), and patients with chronic skin ulceration had the highest risk of Accident & Emergency (hereafter A&E) department visits (1.73 [1.61-1.85]). The second study examined whether multiple long-term conditions in people living with dementia are associated with increased risks of 30-day unplanned readmissions. The study revealed that a one-level increase in multiple long-term conditions increased the risk of all-cause readmission by around 5% and the risk of ambulatory care-sensitive condition readmissions that were potentially preventable in an outpatient setting increased by around 4%. Additionally, compared with cardiovascular risk cluster, diabetic heart disease cluster had the highest risk for all-cause readmissions, followed by heart-related cluster, digestive system cluster, and ocular-gastrointestinal disorders cluster. Compared with cardiovascular risk cluster, heart-related cluster had the highest risk for all ambulatory care-sensitive condition readmissions, followed by diabetic heart disease cluster. The third study observed the association of multiple long-term conditions with mortality in people living with dementia and found pneumonia was the leading cause of death, accounting for 26.2% of all deaths, followed by cardiovascular diseases (6.8%), malignant neoplasms (3.8%), and genitourinary conditions (3.2%). The proportion of study subjects with a death record related to dementia was only 0.7%. Multiple long-term conditions significantly increased the risk of all-cause mortality; comorbid chronic skin ulceration had the highest odds ratio for mortality risk, followed by chronic kidney diseases, COPD emphysema chronic bronchitis, other respiratory diseases, anaemia, and chronic cardiovascular disease. Findings from this real-world research show that multiple long-term conditions contributed independently and substantially to hospitalizations, A&E department visits, potentially avoidable readmissions, and mortality risk in people living with dementia. It highlights the role of better management and proactive interventions for multiple long-term conditions in reducing intensive healthcare utilization and improving health outcomes. The findings may be applicable to similar ageing societies. (494 words)