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Original Articles
Overall and cause-specific mortality in patients with dementia: a population-based cohort study in Taiwan
Chia-Lun Kuo, Pei-Chen Lee, Li-Jung Elizabeth Ku, Yu Sun, Tsung-Hsueh Lu, Muhammad Atoillah Isfandiari, Chung-Yi Li
Epidemiol Health. 2023;45:e2023082.   Published online August 31, 2023
DOI: https://doi.org/10.4178/epih.e2023082
  • 5,617 View
  • 126 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Information regarding the underlying causes of death (UCODs) and standardized mortality ratio (SMR) of dementia is instrumental in formulating medical strategies to prolong life in persons with dementia (PWD). We examined the leading UCODs among PWD and estimated the overall and cause-specific SMRs in relation to dementia in Taiwan.
METHODS
Data were retrieved from 2 national datasets: the Taiwan Death Registry and the medical claim datasets of the National Health Insurance program. The observed person-years for each study participant were counted from the date of cohort enrollment to either the date of death or the final day of 2016. Sex-specific and age-specific SMRs were then calculated.
RESULTS
The leading UCOD was circulatory disease, accounting for 26.0% of total deaths (n=3,505), followed by respiratory disease at 21.3% (n=2,875). PWD were at significantly increased risk of all-cause mortality (SMR, 2.01), with SMR decreasing with advancing age. A cause-specific analysis revealed that the highest SMRs were associated with nervous system diseases (SMR, 7.58) and mental, behavioral, and neurodevelopmental disorders (SMR, 4.80). Age appeared to modify SMR, suggesting that younger age at cohort enrollment was linked to higher SMRs for nearly all causes of mortality.
CONCLUSIONS
Circulatory and respiratory diseases were the leading UCODs among PWD. The particularly elevated mortality due to nervous system diseases and mental disorders suggests that allocating more resources to neurological and psychiatric services is warranted. The elevated SMRs of various UCODs among younger PWD underscore the need for clinicians to pay particular attention to the medical care provided to these patients.
Summary
Key Message
Circulatory diseases were the leading causes of death in patients with dementia (PWD) in Taiwan, which accounted for 26% of the total deaths, followed by diseases of the respiratory system (21.32%). PWD were at a significantly increased risk of all-cause mortality (SMR: 2.01). A greater increase in cause specific SMR was noted for nervous system diseases (SMR: 7.58) and mental, behavioral and neurodevelopmental disorders (SMR: 4.80). Age tended to modify the SMRs in PWD, which indicated the younger the age of cohort enrollment was, the higher the SMRs of nearly all causes of mortality were.

Citations

Citations to this article as recorded by  
  • Trends in incidence, mortality, dynamic needs and rapid evolution of healthcare in dementia
    Ke-Zong Ma, Chaur-Jong Hu
    Archives of Gerontology and Geriatrics.2024; 121: 105389.     CrossRef
  • Associations of cognitive impairment and functional limitation with all-cause mortality risk in older adults: A population-based study from the National Health and Nutrition Examination Survey
    Wenxiu Zhu, Xuyan Zhao, Qingqin Xu, Yun Xue
    Applied Neuropsychology: Adult.2024; : 1.     CrossRef
A Comparison of Occupation, Education, and Cause of Death from National Death Certificates and Deaths Data Due to Workplace Injuries from WELCO in Korea.
Mia Son
Korean J Epidemiol. 2001;23(2):44-51.
  • 39,484 View
  • 19 Download
AbstractAbstract PDF
Abstract
PURPOSE
The variables (occupation, education, cause of death, age, and sex) on death certificates can be used for health related studies, however, there has been little research on health related studies using death certificates in Korea. Also, the validity of the values of these variables on death certificates is questionable in Korea. Therefore, we compared occupation, data obtained from WELCO(Korea Labour Welfare Corporation) between 1995 and 1997.
METHODS
WELCO data on deaths due to workplace injury between 1995-1997 were merged with data from NSO on deaths occurring during the same period, using social security numbers. Out of a total of 7,698 deaths due to workplace injury reported to WELCO between 1995 and 1997, final study population are linked to 6,513 deaths among aged 20-64 between 1995 and 1997. On linking the data sets, two different sources of data are cross-tabulated to determine the percentage of agreement. Expected agreement and Kappa index are also calculated.
RESULTS
The results are as follows : Some manual workers are promoted into the non-manual group in the national death data from the National Statistics Office. Educational groups are promoted or demoted between NSO and WELCO death data. The Kappa index for occupational group is 0.49 when the occupational groups are categorised as manual and non-manual workers. The Kappa index is 0.50 in the two-category classification for education : beyond and below university levels; 0.32 in the three-category classification : university, high-school and less than middle-school; 0.25 in the four category classification : university, high-school, middle-school and less than elementary school. The Kappa index is 0.69 for the three-category disease classification : injury, poisoning and certain other consequences of external causes (S00-T98, ICD10), disease of the circulatory system(I00-I99, ICD10) and other disease categories except the two-category classification. The Kappa index for the 5-year age band is 0.99. There is no disagreement for the sex.
CONCLUSIONS
The comparison between national workplace injury data and national death data and tells us that occupational and educational variables are not in the range of 'excellent agreement' suggested by Koch(1997). Our comparison study suggests strong prediction of random errors as well as systemic errors. As for the cause of death, injury and cardiovascular disease from the NSO data are well-matched with those from the WELCO workplace injury death data. However, this comparison may have a limitation as the present study is confined to comparing only the categories of infury and cardiovascular disease. This study suggests that national death data as well as workplace injury data need to be improved for use as health indicators in studies relating socio-economic factors and working conditions to mortality in Korea.
Summary
Epidemiol Health : Epidemiology and Health
© Korean Society of Epidemiology.
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