Timing of risk factors, prodromal features, and comorbidities of dementia from a large health claims case–control study
Abstract Background Many risk factors for dementia have been identified, but the timing of risk is less well understood. Here, we analyzed risk factors in a case–control study covering 10 years before an incident dementia diagnosis. Methods We designed a case–control study using insurance claims of...
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BMC
2025-01-01
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| Series: | Alzheimer’s Research & Therapy |
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| Online Access: | https://doi.org/10.1186/s13195-024-01662-x |
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| author | Stefan Teipel Manas Akmatov Bernhard Michalowsky Steffi Riedel-Heller Jens Bohlken Jakob Holstiege |
| author_facet | Stefan Teipel Manas Akmatov Bernhard Michalowsky Steffi Riedel-Heller Jens Bohlken Jakob Holstiege |
| author_sort | Stefan Teipel |
| collection | DOAJ |
| description | Abstract Background Many risk factors for dementia have been identified, but the timing of risk is less well understood. Here, we analyzed risk factors in a case–control study covering 10 years before an incident dementia diagnosis. Methods We designed a case–control study using insurance claims of outpatient consultations of patients with German statutory health insurance between January 1, 2012, and December 31, 2022. We included patients with an incident diagnosis of dementia and controls without a diagnosis of dementia matched 1:2 for age, sex, region, and earliest year of outpatient encounter. We selected exposures based on previous systematic reviews, case–control and cohort studies reporting on risk factors, comorbidities, and prodromal features of dementia. We calculated the prevalence of risk factors in cases and controls and odds ratios for each year before the index date, along with Bonferroni-corrected confidence intervals, using conditional logistic regression. Results We identified a total of 1,686,759 patients with incident dementia (mean (SD) age, 82.15 (6.90) years; 61.70% female) and 3,373,518 matched controls (mean (SD) age, 82.15 (6.90) years; 61.70% female). Study participants were followed up for a mean (SD) of 6.6 (2.3) years. Of the 63 risk factors and prodromal features examined, 56 were associated with an increased risk of dementia in all years during the 10th and the 1st year before the index date. These included established risk factors, such as depression, hypertension, hearing impairment, nicotine and alcohol abuse, obesity, hypercholesterolaemia, traumatic brain injury, and diabetes. The greatest risk, with odds ratios greater than 2.5, was conferred by delirium, memory impairment, mental retardation, personality and behavioral disorders, sensory disorders, schizophrenia, and psychosis. Cancer was associated with a reduced risk of dementia. Conclusions This large case–control study confirmed established risk factors of dementia. In addition, the study identified non-specific diagnoses that showed a steep increase in risk close to the index date, such as psychosis, conduct disorder, and other sensory disorders. Consideration of these diagnoses, which may represent prodromal features rather than risk factors for dementia, may help to identify people with dementia in routine care. |
| format | Article |
| id | doaj-art-7d158c3b7c8c47809fdf06151ab4c749 |
| institution | Kabale University |
| issn | 1758-9193 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Alzheimer’s Research & Therapy |
| spelling | doaj-art-7d158c3b7c8c47809fdf06151ab4c7492025-01-19T12:12:56ZengBMCAlzheimer’s Research & Therapy1758-91932025-01-0117111610.1186/s13195-024-01662-xTiming of risk factors, prodromal features, and comorbidities of dementia from a large health claims case–control studyStefan Teipel0Manas Akmatov1Bernhard Michalowsky2Steffi Riedel-Heller3Jens Bohlken4Jakob Holstiege5German Center for Neurodegenerative Diseases (DZNE) Rostock/GreifswaldDepartment of Epidemiology and Healthcare Atlas, Central Research Institute of Ambulatory Health Care in GermanyGerman Center for Neurodegenerative Diseases (DZNE)Institute of Social Medicine, Occupational Health and Public Health, Faculty of Medicine, University of LeipzigInstitute of Social Medicine, Occupational Health and Public Health, Faculty of Medicine, University of LeipzigDepartment of Epidemiology and Healthcare Atlas, Central Research Institute of Ambulatory Health Care in GermanyAbstract Background Many risk factors for dementia have been identified, but the timing of risk is less well understood. Here, we analyzed risk factors in a case–control study covering 10 years before an incident dementia diagnosis. Methods We designed a case–control study using insurance claims of outpatient consultations of patients with German statutory health insurance between January 1, 2012, and December 31, 2022. We included patients with an incident diagnosis of dementia and controls without a diagnosis of dementia matched 1:2 for age, sex, region, and earliest year of outpatient encounter. We selected exposures based on previous systematic reviews, case–control and cohort studies reporting on risk factors, comorbidities, and prodromal features of dementia. We calculated the prevalence of risk factors in cases and controls and odds ratios for each year before the index date, along with Bonferroni-corrected confidence intervals, using conditional logistic regression. Results We identified a total of 1,686,759 patients with incident dementia (mean (SD) age, 82.15 (6.90) years; 61.70% female) and 3,373,518 matched controls (mean (SD) age, 82.15 (6.90) years; 61.70% female). Study participants were followed up for a mean (SD) of 6.6 (2.3) years. Of the 63 risk factors and prodromal features examined, 56 were associated with an increased risk of dementia in all years during the 10th and the 1st year before the index date. These included established risk factors, such as depression, hypertension, hearing impairment, nicotine and alcohol abuse, obesity, hypercholesterolaemia, traumatic brain injury, and diabetes. The greatest risk, with odds ratios greater than 2.5, was conferred by delirium, memory impairment, mental retardation, personality and behavioral disorders, sensory disorders, schizophrenia, and psychosis. Cancer was associated with a reduced risk of dementia. Conclusions This large case–control study confirmed established risk factors of dementia. In addition, the study identified non-specific diagnoses that showed a steep increase in risk close to the index date, such as psychosis, conduct disorder, and other sensory disorders. Consideration of these diagnoses, which may represent prodromal features rather than risk factors for dementia, may help to identify people with dementia in routine care.https://doi.org/10.1186/s13195-024-01662-xRisk trajectoryCancerHypertensionBehavioral disordersOdds ratioDementia incidence |
| spellingShingle | Stefan Teipel Manas Akmatov Bernhard Michalowsky Steffi Riedel-Heller Jens Bohlken Jakob Holstiege Timing of risk factors, prodromal features, and comorbidities of dementia from a large health claims case–control study Alzheimer’s Research & Therapy Risk trajectory Cancer Hypertension Behavioral disorders Odds ratio Dementia incidence |
| title | Timing of risk factors, prodromal features, and comorbidities of dementia from a large health claims case–control study |
| title_full | Timing of risk factors, prodromal features, and comorbidities of dementia from a large health claims case–control study |
| title_fullStr | Timing of risk factors, prodromal features, and comorbidities of dementia from a large health claims case–control study |
| title_full_unstemmed | Timing of risk factors, prodromal features, and comorbidities of dementia from a large health claims case–control study |
| title_short | Timing of risk factors, prodromal features, and comorbidities of dementia from a large health claims case–control study |
| title_sort | timing of risk factors prodromal features and comorbidities of dementia from a large health claims case control study |
| topic | Risk trajectory Cancer Hypertension Behavioral disorders Odds ratio Dementia incidence |
| url | https://doi.org/10.1186/s13195-024-01662-x |
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