Background
Methods
Setting
Data sources
Cohort
Selection of case definition criteria
Study/Institute | Case definition algorithmb | Age group | Timeframe |
---|---|---|---|
Present studya | ≥1 physician visits or ≥ 1 hospitalizations or ≥ 1 prescriptions for a cholinesterase inhibitor or [a RAI-MDS CPS score of ≥ 2 and/or (a disease category of Alzheimer’s disease or dementia other than Alzheimer’s disease)] | ≥45 years | 1 year (2012–2013) |
Manitoba Centre for Health Policy [38]c | ≥1 physician visits or ≥ 1 hospitalizations | ≥55 years | Not applicableb |
Chartier et al. [39] | ≥1 physician visits or ≥ 1 hospitalizations | ≥55 years | 5 years (2004–2009) |
Martens et al. [40] | ≥1 physician visits or ≥ 1 hospitalizations | ≥55 years | 5 years (2002–2007) |
Fransoo et al. [41] | ≥1 physician visits or ≥ 1 hospitalizations | ≥55 years | 5 years (1996–2001) and 5 years (2001–2006) |
Gill et al. [42] | ≥1 physician visits or ≥ 1 hospitalizations or any cholinesterase inhibitor prescription | 66-105 years | 5 years (2002–2007) for physician and hospital data; 1 year for prescription data (2006–2007) |
Jacklin et al. [43] | ≥1 physician visits | all ages | 1 year (2008–2009) |
Jacklin and Walker [44] | ≥2 physician visits or ≥ 1 hospitalizations | ≥60 years | 1 year (2006–2007) |
Case definition criteria
Measures
Statistical analysis
Ethics
Results
Incidence by sex and age group
Age group | n | PAR | Rate per 1,000 PAR (95 % CI) |
---|---|---|---|
45-54 | 70 | 153,189 | 0.46 (0.35-0.56) |
55-64 | 177 | 137,916 | 1.28 (1.07-1.47) |
65-74 | 329 | 83,198 | 3.95 (3.53-4.38) |
75-84 | 1,014 | 50,616 | 20.03 (18.80-21.27) |
85+ | 1,680 | 24,093 | 69.73 (66.40-73.06) |
Total | 3,270 | 449,012 | 7.28 (7.03-7.53) |
Age group | Female | Male | ||||||
---|---|---|---|---|---|---|---|---|
n | PAR | Crude rate per 1,000 PAR (95 % CI) | Age-standardised rate per 1,000 PAR (95 % CI) | n | PAR | Crude rate per 1,000 PAR (95 % CI) | Age-standardised rate per 1,000 PAR (95 % CI) | |
45-54 | 37 | 75,597 | 0.49 (0.33-0.65) | 0.49 (0.33-0.65) | 33 | 77,592 | 0.43 (0.28-0.57) | 0.43 (0.28-0.57) |
55-64 | 85 | 67,958 | 1.25 (0.98-1.52) | 1.25 (0.99-1.52) | 92 | 69,958 | 1.32 (1.05-1.58) | 1.32 (1.05-1.58) |
65-74 | 165 | 42,193 | 3.91 (3.31-4.51) | 3.88 (3.29-4.47) | 164 | 41,005 | 4.00 (3.39-4.61) | 4.02 (3.41-4.64) |
75-84 | 539 | 27,767 | 19.41 (17.77-21.05) | 19.26 (17.63-20.88) | 475 | 22,849 | 20.79 (18.92-22.66) | 21.05 (19.16-22.94) |
85+ | 1,061 | 15,267 | 69.50 (65.31-73.68) | 67.13 (63.09-71.17) | 619 | 8,826 | 70.13 (64.61-75.66) | 74.38 (68.52-80.24) |
Total | 1,887 | 228,782 | 8.25 (7.88-8.62) | 7.04 (6.72-7.36) | 1,383 | 220,230 | 6.28 (5.95-6.61) | 7.65 (7.25-8.06) |
Age group | Female age-standardised rate per 1,000 PAR | Male age-standardised rate per 1,000 PAR | Rate ratio | SD (RR) | 95 % CI |
---|---|---|---|---|---|
45-54 | 0.49 | 0.43 | 1.14 | 0.24 | 0.712-1.822 |
55-64 | 1.25 | 1.32 | 0.95 | 0.15 | 0.705-1.272 |
65-74 | 3.88 | 4.02 | 0.97 | 0.11 | 0.778-1.198 |
75-84 | 19.26 | 21.05 | 0.91 | 0.06 | 0.809-1.035 |
85+ | 67.13 | 74.38 | 0.90 | 0.05 | 0.817-0.997 |
Total | 7.04 | 7.65 | 0.92 | 0.04 | 0.859-0.986 |
Prevalence by sex and age group
Age group | n | PAR | Rate per 1,000 PAR (95 % CI) |
---|---|---|---|
45-54 | 211 | 153,400 | 1.38 (1.19-1.56) |
55-64 | 876 | 138,792 | 6.31 (5.89-6.73) |
65-74 | 1,391 | 84,589 | 16.44 (15.58-17.31) |
75-84 | 3,687 | 54,303 | 67.90 (65.71-70.09) |
85+ | 6,847 | 30,940 | 221.30 (216.06-226.54) |
Total | 13,012 | 462,024 | 28.16 (27.68-28.65) |
Age group | Female | Male | ||||||
---|---|---|---|---|---|---|---|---|
n | PAR | Crude rate per 1,000 PAR (95 % CI) | Age-standardised rate per 1,000 PAR (95 % CI) | n | PAR | Crude rate per 1,000 PAR (95 % CI) | Age-standardised rate per 1,000 PAR (95 % CI) | |
45-54 | 110 | 75,707 | 1.45 (1.18-1.72) | 1.45 (1.18-1.72) | 101 | 77,693 | 1.30 (1.05-1.55) | 1.30 (1.05-1.56) |
55-64 | 446 | 68,404 | 6.52 (5.91-7.13) | 6.52 (5.91-7.12) | 430 | 70,388 | 6.11 (5.53-6.69) | 6.11 (5.53-6.69) |
65-74 | 694 | 42,887 | 16.18 (14.98-17.39) | 16.12 (14.92-17.32) | 697 | 41,702 | 16.71 (15.47-17.95) | 16.79 (15.54-18.03) |
75-84 | 2,034 | 29,801 | 68.25 (65.29-71.22) | 67.56 (64.62-70.50) | 1,653 | 24,502 | 67.46 (64.21-70.72) | 68.24 (64.95-71.53) |
85+ | 4,815 | 20,082 | 239.77 (232.99-246.54) | 231.94 (225.39-238.49) | 2,032 | 10,858 | 187.14 (179.01-195.28) | 196.16 (187.63-204.69) |
Total | 8,099 | 236,881 | 34.19 (33.45-34.93) | 28.92 (28.29-29.55) | 4,913 | 225,143 | 21.82 (21.21-22.43) | 26.53 (25.78-27.27) |
Age group | Female age-standardised rate per 1,000 PAR | Male age-standardised rate per 1,000 PAR | Rate ratio | SD (RR) | 95 % CI |
---|---|---|---|---|---|
45-54 | 1.45 | 1.30 | 1.12 | 0.138 | 0.851-1.461 |
55-64 | 6.52 | 6.11 | 1.07 | 0.068 | 0.935-1.218 |
65-74 | 16.12 | 16.79 | 0.96 | 0.054 | 0.864-1.067 |
75-84 | 67.56 | 68.24 | 0.99 | 0.033 | 0.928-1.056 |
85+ | 231.94 | 196.16 | 1.18 | 0.027 | 1.123-1.245 |
Total | 28.92 | 26.53 | 1.09 | 0.018 | 1.052-1.129 |
Incidence and prevalence by diagnosis code and other criteria
Database and diagnosis code/other criteria | Description of diagnosis code/other criteria | Incident cases | Prevalent cases | ||||
---|---|---|---|---|---|---|---|
n | Rate per 100 with incident dementiaa | Rate per 10,000 PARb | n | Rate per 100 with prevalent dementiac | Rate per 10,000 PARd | ||
Hospital Discharge Abstract Database (ICD-10-CA Codes) | |||||||
F00.0 | Dementia in Alzheimer’s Disease with early onset | <6 | * | * | 9 | 0.07 | 0.19 |
F00.1 | Dementia in Alzheimer’s Disease with late onset | <6 | * | * | 16 | 0.12 | 0.35 |
F00.2 | Dementia in Alzheimer’s Disease, atypical or mixed type | <6 | * | * | 19 | 0.15 | 0.41 |
F00.9 | Dementia in Alzheimer’s Disease, unspecified | 38 | 1.16 | 0.85 | 156 | 1.20 | 3.38 |
F01.0 | Vascular dementia of acute onset | <6 | * | * | <6 | * | * |
F01.1 | Multifarct dementia | 10 | 0.31 | 0.22 | 26 | 0.20 | 0.56 |
F01.2 | Subcortical vascular dementia | <6 | * | * | 7 | 0.05 | 0.15 |
F01.3 | Mixed cortical and subcortical vascular dementia | <6 | * | * | <6 | * | * |
F01.8 | Other vascular dementia | <6 | * | * | 14 | 0.11 | 0.30 |
F01.9 | Vascular dementia, unspecified | 47 | 1.44 | 1.05 | 189 | 1.45 | 4.09 |
F02.0 | Dementia in Pick’s disease | <6 | * | * | 14 | 0.11 | 0.30 |
F02.1 | Dementia in Creutzfeldt-Jakob disease | <6 | * | * | 0 | ||
F02.2 | Dementia in Huntington’s disease | 0 | <6 | * | * | ||
F02.3 | Dementia in Parkinson’s disease | 22 | 0.67 | 0.49 | 68 | 0.52 | 1.47 |
F02.4 | Dementia in human immunodeficiency virus HIV disease | 0 | <6 | * | * | ||
F02.8 | Dementia in other specified diseases classified elsewhere | <6 | * | * | 16 | 0.12 | 0.35 |
F03 | Unspecified dementia | 611 | 18.69 | 13.61 | 1,737 | 13.35 | 37.60 |
F04 | Organic amnesic syndrome, not induced by alcohol and other psychoactive substances | 0 | <6 | * | * | ||
F05.1 | Delirium superimposed on dementia | 54 | 1.65 | 1.20 | 158 | 1.21 | 3.42 |
F06.8 | Other specified mental disorders due to brain damage and dysfunction and to physical disease | 0 | 15 | 0.12 | 0.32 | ||
F06.9 | Unspecified mental disorder due to brain damage and dysfunction and to physical disease | <6 | * | * | 108 | 0.83 | 2.34 |
F09 | Unspecified organic or symptomatic mental disorder | <6 | * | * | 14 | 0.11 | 0.30 |
F10.6 | Mental and behavioural disorders due to use of alcohol, amnesic syndrome | 13 | 0.40 | 0.29 | 61 | 0.47 | 1.32 |
F10.7 | Mental and behavioural disorders due to use of alcohol, residual and late-onset psychotic disorder | 8 | 0.24 | 0.18 | 59 | 0.45 | 1.28 |
F18.6 | Mental and behavioural disorders due to use of volatile solvents, amnesic syndrome | 0 | 0 | 0.00 | 0.00 | ||
F18.7 | Mental and behavioural disorders due to use of volatile solvents, residual and late-onset psychotic disorder | 0 | 0 | 0.00 | 0.00 | ||
F19.6 | Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances, amnesic syndrome | 0 | <6 | * | * | ||
F19.7 | Mental and behavioural disorders due to multiple drug use and use of psychoactive substances, residual and late-onset psychotic disorder | 0 | <6 | * | * | ||
G30.0 | Alzheimer’s disease with early onset | 0 | 6 | 0.05 | 0.13 | ||
G30.1 | Alzheimer’s disease with late onset | <6 | * | * | 10 | 0.08 | 0.22 |
G30.8 | Other Alzheimer’s disease | 0 | 18 | 0.14 | 0.39 | ||
G30.9 | Alzheimer’s disease, unspecified | 24 | 0.73 | 0.53 | 141 | 1.08 | 3.05 |
G31.0 | Circumscribed brain atrophy | 0 | <6 | * | * | ||
G31.1 | Senile degeneration of brain, not elsewhere classified | <6 | * | * | 7 | 0.05 | 0.15 |
G91.0 | Communicating hydrocephalus | <6 | * | * | <6 | * | * |
G91.2 | Normal-pressure hydrocephalus | 8 | 0.24 | 0.18 | 49 | 0.38 | 1.06 |
R54 | Senility | 74 | 2.26 | 1.65 | 161 | 1.24 | 3.48 |
Total Hospital Discharge Abstract Database (ICD-10-CA Codes) | 933 | 28.53 | 20.78 | 3,102 | 23.84 | 67.14 | |
Physician Services Claims Database & Physician Characteristics Database (ICD-9 Codes) | |||||||
290 | Senile and presenile organic psychotic conditions | 441 | 13.49 | 9.82 | 1,709 | 13.13 | 36.99 |
294 | Other organic psychotic conditions chronic | 23 | 0.70 | 0.51 | 107 | 0.82 | 2.32 |
331 | Other cerebral degenerations | 471 | 14.40 | 10.49 | 3,205 | 24.63 | 69.37 |
797 | Senility without mention of psychosis | 44 | 1.35 | 0.98 | 204 | 1.57 | 4.42 |
Total Physician Services Claims Database (ICD-9 codes) | 979 | 29.94 | 21.80 | 5,225 | 40.16 | 113.09 | |
Prescription Drug Database | |||||||
Cholinesterase Inhibitor | |||||||
02232043, 02232044 | Aricept | 6+ | * | * | 1,068 | 8.21 | 23.12 |
02242115-02242118, 02245240 | Exelon | <6 | * | * | 63 | 0.48 | 1.36 |
02244298-02244300, 02266717, 02266725, 02266733 | Reminyl | <6 | * | * | 337 | 2.59 | 7.29 |
Total Prescription Drug Database | 214 | 6.54 | 4.77 | 1,468 | 11.28 | 31.77 | |
Resident Assessment Index – Minimum Data Set (RAI-MDS) | |||||||
CPS Scale Scoree | |||||||
2 | Mild impairment (MMSE EA 19) | 442 | 13.52 | 9.84 | 1118 | 8.59 | 24.20 |
3 | Moderate impairment (MMSE EA 15) | 441 | 13.49 | 9.82 | 1359 | 10.44 | 29.41 |
4 | Moderately severe impairment (MMSE EA 7) | 78 | 2.39 | 1.74 | 202 | 1.55 | 4.37 |
5 | Severe impairment (MMSE EA 5) | 110 | 3.36 | 2.45 | 355 | 2.73 | 7.68 |
6 | Very severe impairment (MMSE EA 1) | 35 | 1.07 | 0.78 | 91 | 0.70 | 1.97 |
Disease category | |||||||
mds_l1r | Alzheimer’s Disease and CPS < 2 | <6 | * | * | 11 | 0.08 | 0.24 |
mds_l1v | Dementia other than Alzheimer’s Disease and CPS < 2 | 6+ | * | * | 81 | 0.62 | 1.75 |
Total Resident Assessment Index – Minimum Data Set (RAI-MDS) | 1,144 | 34.98 | 25.48 | 3,217 | 24.72 | 69.63 | |
TOTAL four databases | 3,270 | 100.00 | 72.83 | 13,012 | 100.00 | 281.63 |
Criteria at first identification of dementia | Incident cases (N = 1,144) | Prevalent cases (N = 3,217) | ||||||
---|---|---|---|---|---|---|---|---|
First identification at admissiona | First identification ≥30 days after admissionb | First identification at admissionb | First identification ≥30 days after admissionb | |||||
n | % | n | % | n | % | n | % | |
CPS Scale Scorec | ||||||||
2 Mild impairment (MMSE EA 19) | 334 | 75.56 | 108 | 24.44 | 769 | 68.78 | 349 | 31.22 |
3 Moderate impairment (MMSE EA 15) | 358 | 81.17 | 83 | 18.83 | 945 | 69.53 | 414 | 30.46 |
4 Moderately severe impairment (MMSE EA 7) | 70 | 89.74 | 8 | 10.26 | 145 | 71.78 | 57 | 28.22 |
5 Severe impairment (MMSE EA 5) | 95 | 86.36 | 15 | 13.64 | 241 | 67.89 | 114 | 32.11 |
6 Very severe impairment (MMSE EA 1) | 28 | 80.0 | 7 | 20.0 | 52 | 57.14 | 39 | 42.85 |
Disease category | ||||||||
Alzheimer disease and CPS <2 | <6 | * | <6 | * | 6+ | * | <6 | * |
Dementia other than Alzheimer disease and CPS <2 | 6+ | * | 6+ | * | 6+ | * | 6+ | * |
Total | 912 | 79.72 | 232 | 20.28 | 2,216 | 68.89 | 1,001 | 31.11 |