Excess Mortality With Alzheimer Disease and Related Dementias as an Underlying or Contributing Cause During the COVID-19 Pandemic in the US
Open accessAbstract
Importance: Adults with Alzheimer disease and related dementias (ADRD) are particularly vulnerable to the direct and indirect effects of the COVID-19 pandemic. Deaths associated with ADRD increased substantially in pandemic year 1. It is unclear whether mortality associated with ADRD declined when better prevention strategies, testing, and vaccines became widely available in year 2. Objective: To compare pandemic-era excess deaths associated with ADRD between year 1 and year 2 overall and by age, sex, race and ethnicity, and place of death. Design, Setting, and Participants: This time series analysis used all death certificates of US decedents 65 years and older with ADRD as an underlying or contributing cause of death from January 2014 through February 2022. Exposure: COVID-19 pandemic era. Main Outcomes and Measures: Pandemic-era excess deaths associated with ADRD were defined as the difference between deaths with ADRD as an underlying or contributing cause observed from March 2020 to February 2021 (year 1) and March 2021 to February 2022 (year 2) compared with expected deaths during this period. Expected deaths were estimated using data from January 2014 to February 2020 fitted with autoregressive integrated moving average models. Results: Overall, 2 334 101 death certificates were analyzed. A total of 94 688 (95% prediction interval [PI], 84 192-104 890) pandemic-era excess deaths with ADRD were estimated in year 1 and 21 586 (95% PI, 10 631-32 450) in year 2. Declines in ADRD-related deaths in year 2 were substantial for every age, sex, and racial and ethnic group evaluated. Pandemic-era ADRD-related excess deaths declined among nursing home/long-term care residents (from 34 259 [95% PI, 25 819-42 677] in year 1 to −22 050 [95% PI, −30 765 to −13 273] in year 2), but excess deaths at home remained high (from 34 487 [95% PI, 32 815-36 142] in year 1 to 28 804 [95% PI, 27 067-30 571] in year 2). Conclusions and Relevance: This study found that large increases in mortality with ADRD as an underlying or contributing cause of death occurred in COVID-19 pandemic year 1 but were largely mitigated in pandemic year 2. The most pronounced declines were observed for deaths in nursing home/long-term care settings. Conversely, excess deaths at home and in medical facilities remained high in year 2.
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One study found that deaths due to all dementias, including Alzheimer's, decreased between March 2021 and February 2022, in particular among residents of nursing homes and long-term care facilities.
“one study found that deaths due to all dementias, including Alzheimer's, decreased between March 2021 and February 2022, in particular among residents of nursing homes and long‐term care facilities.”
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- Authors
- Chen, R., Charpignon, M.-L., Raquib, R. V., Wang, J., Meza, E., Aschmann, H. E., DeVost, M. A., Mooney, A., Bibbins-Domingo, K., Riley, A. R., Kiang, M. V., Chen, Y.-H., Stokes, A. C., & Glymour, M. M.
- Affiliations
- University of California, San Francisco (US)
- Massachusetts Institute of Technology (US)
- Boston University (US)
- University of California, Santa Cruz (US)
- Stanford Medicine (US)
- Corresponding author
- Glymour, M. Maria
- ORCID
- Venue
- JAMA Neurology
- Publisher
- American Medical Association (AMA)
- Published
- 2023-09-01
- Volume
- 80
- Issue
- 9
- Pages
- 919
- ISSN
- 2168-6149 (ISSN-L)
- PMC
- PMC10352932
- OpenAlex
- W4384522506
- Cited by
- 40
- References
- 36
- Citations by year
- 2026: 10 · 2025: 11 · 2024: 19
- FWCI
- 8.11
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- JAMA Neurology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Funders
- National Institute on Aging (K00AG068431, F31AG079651)
- National Institute on Drug Abuse (K99DA051534)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Keywords
- Alzheimer's disease and related dementias, COVID-19 pandemic, excess mortality, death certificates, nursing home residents, long-term care, home death, racial and ethnic disparities, older adults, COVID-19 vaccines, COVID-19 testing, COVID-19 prevention strategies, mortality decline, United States
- MeSH terms
- COVID-19, Adult, Alzheimer Disease, Humans, Pandemics
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