The Impact of Demographic, Socio-Economic and Geographic Factors on Mortality Risk among People Living with Dementia in England (2002–2016)

Abstract

Increasing numbers of people living with dementia (PLWD), and a pressured health and social care system, will exacerbate inequalities in mortality for PLWD. There is a dearth of research examining multiple factors in mortality risk among PLWD, including application of large administrative datasets to investigate these issues. This study explored variation mortality risk variation among people diagnosed with dementia between 2002–2016, based on: age, sex, ethnicity, deprivation, geography and general practice (GP) contacts. Data were derived from electronic health records from a cohort of Clinical Practice Research Datalink GP patients in England (n = 142,340). Cox proportional hazards regression modelled mortality risk separately for people with early- and later- onset dementia. Few social inequalities were observed in early-onset dementia; men had greater risk of mortality. For early- and later-onset, higher rates of GP observations—and for later-onset only dementia medications—are associated with increased mortality risk. Social inequalities were evident in later-onset dementia. Accounting for other explanatory factors, Black and Mixed/Other ethnicity groups had lower mortality risk, more deprived areas had greater mortality risk, and higher mortality was observed in North East, South Central and South West GP regions. This study provides novel evidence of the extent of mortality risk inequalities among PLWD. Variance in mortality risk was observed by social, demographic and geographic factors, and frequency of GP contact. Findings illustrate need for greater person-centred care discussions, prioritising tackling inequalities among PLWD. Future research should explore more outcomes for PLWD, and more explanatory factors of health outcomes.

Social and spatial inequalities in healthcare use among people living with dementia in England (2002–2016)

“…However, our findings emphasise less need for acute healthcare among PLWD from ethnic minority backgrounds. There is lower mortality risk among PLWD from ethnic minority backgrounds (Watson et al, 2021 ), a finding which may be consistent with younger demographics (insufficiently controlled for in our analysis) and reduced severity of dementia (Parveen & Oyebode, 2018 ). Existing research highlights the barriers in accessing quality healthcare for PLWD from ethnic minority backgrounds (Cooper et al, 2010 ; Lin et al, 2020 ; Mukadam et al, 2011 ; Pham et al, 2018 ), but with reduced severity, there is also less frequent contact with healthcare services (Duran-Kirac et al, 2022 ).…”

“…2015 Indices of Multiple Deprivation (IMD) quintile and GP urban/rural classification was available via data linkage using patients’ GP ID. This study includes these explanatory factors for healthcare use among PLWD, as research illustrates differential provision and quality of healthcare, and health outcomes for PLWD by age (continuous), sex, ethnicity and deprivation, and by spatial factors including level of urbanity/rurality (Rahman et al, 2020 ; Watson et al, 2020 , 2021 ; Wu et al, 2020 ).…”

“…Avoidable healthcare use is associated with more severe dementia, faster deterioration, poorer quality of life, increased mortality risk and greater cost to the healthcare system (Briggs et al, 2017 ; Reynish et al, 2017 ; Sager et al, 1996 ; Tropea et al, 2017 ; van de Vorst et al, 2015 ). Although early diagnosis and effective treatment can reduce avoidable healthcare use and associated negative outcomes (Alzheimer’s Society, 2021 ; Watson et al, 2021 ), a lack of funding for formal services and greater and more acute need among PLWD will likely exacerbate avoidable healthcare use, leading to more proliferate negative health outcomes for PLWD with elevated costs to healthcare services. Some socio-economic groups and geographic areas are more likely to experience a lack of sufficient care, including those from more remote or historically underserved communities (Rahman et al, 2020 ; Thorpe et al, 2010 ; Watson et al, 2020 ).…”

“…Electronic Healthcare Records (EHRs) can be used to identify healthcare use among large cohorts of patients with a specified health condition, such as dementia (Casey et al, 2016 ). EHRs have been employed previously to evidence inequalities in health outcomes (Watson et al, 2020 , 2021 ). Understanding which services PLWD are in contact with, by social and spatial variables, can demonstrate differences associated with healthcare utilisation.…”

Recent research advances in young-onset dementia

“…While males and females had similar survival duration and neurofilament levels, the authors suggested that since females live longer than males in general, that absence of differences in survival could indirectly mean that females have a more aggressive form of disease. Electronic health records from general practices across the United Kingdom were used to investigate various risk factors for mortality in dementia [27 ▪▪ ]. These factors included mixed/other ethnicity (hazard ratio [HR] 1.18), lower socioeconomic status/more deprived areas (HR 1.18) and living in the South Central region of the UK (HR 1.39) and being male (HR 1.24).…”