The online version of this article (doi:10.1186/1471-2318-14-10) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
The analysis of comorbidity complexes was conducted as an add-on to the IDA project, which was initiated and financed by the Federal Association of the AOK, the AOK Bavaria (health insurer) and the research-based pharmaceutical companies Eisai and Pfizer. For LS, RH (Helmholtz Zentrum München) and EG (Department of Medical Psychology and Medical Sociology, Friedrich-Alexander-Universität Erlangen-Nürnberg), their institutions received support from the funding organizations for the submitted work.
All authors were involved in the conception of the research and decided on research question and study design. KB performed the statistical analysis, interpreted the data and drafted the manuscript. LS drafted the statistical models and acted as the corresponding author. Together with RH, she conceived the study, provided statistical support and advised on health care system-related issues. EG was the main contact person for medical issues. All co-authors proofread the manuscript critically and approved its final version.
Multimorbidity is common in advanced age, and is usually associated with negative – yet to some extent preventable – health outcomes. Detecting comorbid conditions is especially difficult in individuals with dementia, as they might not always be able to sufficiently express discomfort. This study compares relevant comorbidity complexes in elderly people with and without dementia, with a particular look at gender- and living environment-specific differences. Moreover, associations between selected comorbid conditions and dementia are reviewed more closely.
Using 2006 claims data from a large German Statutory Health Insurance fund, 9,139 individuals with dementia and 28,614 age- and gender-matched control subjects aged 65 years and older were identified. A total of 30 comorbidity complexes were defined based on ICD-10 codes. Corresponding prevalence rates were calculated, and the association between a distinct condition and dementia was evaluated via logistic regression in the overall sample as well as in analyses stratified by gender and living environment.
Individuals with dementia were more likely to be diagnosed with 15 comorbidity complexes, including Parkinson’s, stroke, diabetes, atherosclerosis (supposed dementia risk factors) or fluids and electrolyte disorders, insomnia, incontinence, pneumonia, fractures and injuries (supposed sequelae). In contrast, they were less likely to be diagnosed with 11 other conditions, which included vision and hearing problems, diseases of the musculoskeletal system, lipoprotein disorders and hypertension. In a gender-stratified analysis, the patterns remained largely the same, but a bigger comorbidity gap between cases and control subjects emerged in the male population. Restricting the analysis to community-living individuals did not lead to any substantial changes.
Besides strengthening the evidence on accepted dementia risk factors and sequelae, the analyses point to particular conditions that are likely to remain untreated or even undiagnosed. This issue seems to affect male and female individuals with dementia to varying degrees. Raising awareness of these conditions is important to possibly preventing comorbidity-associated complications and disease progression in dementia patients. To more comprehensively understand the mutual interactions between dementia and comorbidity, further research on diagnostic and treatment attitudes regarding comorbidity in dementia patients and on their gender-specific health-seeking behaviour seems to be required.
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