Trends in Mortality Rates Among Medicare Enrollees With Alzheimer Disease and Related Dementias Before and During the Early Phase of the COVID-19 Pandemic
Open accessAbstract
IMPORTANCE: The COVID-19 pandemic fundamentally altered the delivery of health care in the United States. The associations between these COVID-19-related changes and outcomes in vulnerable patients, such as among persons with Alzheimer disease and related dementias (ADRD), are not yet well understood. OBJECTIVE: To determine the association between regional rates of COVID-19 infection and excess mortality among individuals with ADRD. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study used data from beneficiaries of 100% fee-for-service Medicare Parts A and B between January 1, 2019, and December 31, 2020, to assess age- and sex-adjusted mortality rates. Participants were 53 640 888 Medicare enrollees 65 years of age or older categorized into 4 prespecified cohorts: enrollees with or without ADRD and enrollees with or without ADRD residing in nursing homes. EXPOSURES: Monthly COVID-19 infection rates by hospital referral region between January and December 2020. MAIN OUTCOMES AND MEASURES: Mortality rates from March through December 2020 were compared with those from March through December 2019. Excess mortality was calculated by comparing mortality rates in 2020 with rates in 2019 for specific, predetermined groups. Means were compared using t tests, and 95% CIs were estimated using the delta method. RESULTS: This cross-sectional study included 26 952 752 Medicare enrollees in 2019 and 26 688 136 enrollees in 2020. In 2019, the mean (SD) age of community-dwelling beneficiaries without ADRD was 74.1 (8.8) years and with ADRD was 82.6 (8.4) years. The mean (SD) age of nursing home residents with ADRD (83.6 [8.4] years) was similar to that for patients without ADRD (79.7 [8.8] years). Among patients diagnosed as having ADRD in 2019, 63.5% were women, 2.7% were Asian, 9.2% were Black, 5.7% were Hispanic, 80.7% were White, and 1.7% were identified as other (included all races or ethnicities other than those given); the composition did not change appreciably in 2020. Compared with 2019, adjusted mortality in 2020 was 12.4% (95% CI, 12.1%-12.6%) higher among enrollees without ADRD and 25.7% (95% CI, 25.3%-26.2%) higher among all enrollees with ADRD, with even higher percentages for Asian (36.0%; 95% CI, 32.6%-39.3%), Black (36.7%; 95% CI, 35.2%-38.2%), and Hispanic (40.1%; 95% CI, 37.9%-42.3%) populations with ADRD. The hospital referral region in the lowest quintile for COVID-19 infections in 2020 had no excess mortality among enrollees without ADRD but 8.8% (95% CI, 7.5%-10.2%) higher mortality among community-dwelling enrollees with ADRD and 14.2% (95% CI, 12.2%-16.2%) higher mortality among enrollees with ADRD living in nursing homes. CONCLUSIONS AND RELEVANCE: The results of this cross-sectional study suggest that the COVID-19 pandemic may be associated with excess mortality among older adults with ADRD, especially for Asian, Black, and Hispanic populations and people living in nursing homes, even in areas with low COVID-19 prevalence.
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Among Medicare beneficiaries age 65 and over with Alzheimer's disease and other dementias, overall mortality increased 26% between 2019 and 2020, which is twice as high as the increase among beneficiaries without Alzheimer's disease and other dementias.
“Among Medicare beneficiaries age 65 and over with Alzheimer's disease and other dementias, overall mortality increased 26% between 2019 and 2020, which is twice as high as the increase among beneficiaries without Alzheimer's disease and other dementias.”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [416]
The Results report age- and sex-adjusted mortality 25.7% higher for enrollees with ADRD and 12.4% higher for those without—approximately a twofold difference. The Methods specify that these comparisons cover March through December of each year, not the full calendar years implied by the unqualified claim. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAmong Medicare beneficiaries age 65 and older with Alzheimer's disease and other dementias, overall mortality increased 26% between 2019 and 2020, twice as high as the increase for beneficiaries without these conditions.
“Among Medicare beneficiaries age 65 and older with Alzheimer's disease and other dementias, overall mortality increased 26% between 2019 and 2020, which is twice as high as the increase for beneficiaries without Alzheimer's disease and other dementias.”
From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [386]
Increased mortality between 2019 and 2020 among Medicare beneficiaries with Alzheimer's disease and related dementia was greater among Black, Hispanic, and Asian beneficiaries than among White beneficiaries and the nursing home population.
“increased mortality between 2019 and 2020 among Medicare beneficiaries with Alzheimer's disease and related dementia was greater among Black, Hispanic, and Asian beneficiaries than among White beneficiaries and the nursing home population.”
From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [386]
Increased mortality between 2019 and 2020 among Medicare beneficiaries with Alzheimer's disease and related dementia was greater among Black, Hispanic and Asian beneficiaries than among White beneficiaries and the nursing home population.
“increased mortality between 2019 and 2020 among Medicare beneficiaries with Alzheimer's disease and related dementia was greater among Black, Hispanic and Asian beneficiaries than among White beneficiaries and the nursing home population.”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [416]
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Dementia and Cognitive Impairment
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- Authors
- Gilstrap, L., Zhou, W., Alsan, M., Nanda, A., & Skinner, J. S.
- Affiliations
- Dartmouth College (US)
- National Bureau of Economic Research (US)
- Corresponding author
- Gilstrap, Lauren
- Venue
- JAMA Neurology
- Publisher
- American Medical Association (AMA)
- Published
- 2022-04-01
- Volume
- 79
- Issue
- 4
- Pages
- 342
- ISSN
- 2168-6149 (ISSN-L)
- PMC
- PMC8886452
- OpenAlex
- W4214707160
- Cited by
- 77
- References
- 34
- Citations by year
- 2026: 8 · 2025: 17 · 2024: 17 · 2023: 23 · 2022: 12
- FWCI
- 11.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Neurology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (P01AG005842)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Keywords
- Alzheimer's disease and related dementias, COVID-19 pandemic, excess mortality, mortality trends, nursing home residents, Medicare enrollees, older adults, hospital referral regions, COVID-19 infection rates, healthcare disruption, vulnerable populations, racial and ethnic disparities, long-term care, community-dwelling older adults, 2020-2021 pandemic period
- MeSH terms
- COVID-19, Aged, Alzheimer Disease, Child, Cross-Sectional Studies, Female, Medicare, Humans, Retrospective Studies, United States, Pandemics
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