Public Health Impact of Cardiometabolic Diseases on Incident Lewy Body Dementia in the U.S. Medicare Population
George Karway1, Brittany Krzyzanowski2, Jordan Killion2, Irene Faust2, Osvaldo Laurido-Soto3, Brad Racette2
1Neuro Epidemiology, Barrow Neurological Institute, 2Barrow Neurological Institute, 3Washington University
Objective:
Understanding the impact of cardiometabolic diseases (CMDs) on incident Lewy body dementia (LBD) can inform primary preventative measures.
Background:
Studies suggest that LBD risk factors are similar to those for Alzheimer’s disease, including CMDs. Regional variations in CMDs across the US may contribute differentially to LBD disease risk.
Design/Methods:
We utilized nationwide, population-based Medicare data to identify all incident LBD cases (N=93,005) in 2017-2018 and frequency matched controls 5:1 (N=465,025) by month and year of LBD diagnosis. LBD was defined as either having an ICD-10 code for dementia with Lewy bodies or having incident PD with dementia two-year prior or one-year following. Exposure variables were the prevalence of eight CMDs: acute myocardial infarction (AMI), ischemic heart disease (IHD), atrial fibrillation, chronic heart failure, diabetes, hypertension, hyperlipidemia, and stroke. We computed the odd ratios (ORs) and 95% confidence intervals (CIs) of LBD for each demographic and CMD variable along with their individual and combined population attributable fractions (PAFs). ORs and PAF were adjusted for age, sex, and race/ethnicity. We mapped county-level PAFs using geospatial smoothing.
Results:
LBD cases were older (OR=1.091, 95% CI: 1.090-1.092) and more commonly male (OR=1.624, 95% CI: 1.601-1.648) than controls. All CMDs were positively associated with LBD, with ORs ranging from 1.257 (95% CI: 1.221-1.294) for AMI to 2.343 (95% CI: 2.303-2.383) for stroke. The nationwide combined weighted PAF for the CMDs was 43.0%, with hypertension (36.1%), hyperlipidemia (23.4%), and IHD (22.2%) having the greatest individual PAFs. The highest county-level PAFs of CMDs on LBD were in the South and part of the Midwest and Northeast.
Conclusions:
Incident LBD cases among Medicare beneficiaries could be reduced substantially by mitigating CMD risk factors. CMDs disproportionally affect LBD burden in the South, part of Michigan, and Northeast.
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