22-Year Analysis on Aspiration Pneumonia-Related Mortality Among Alzheimer’s Patients in the United States
Rawdah Shakil1, Amna Rizwan Bhatti2, Shahzaib Khan3, Momina Javed4, Manahil Rehan5, Abdullah Akram6, Fatima Najam3, Hamza Shakil7, Sabin Zafar8, Faraz Arshad9
1Dow International Medical College, Karachi, 2Federal Medical and Dental College, Islamabad, 3King Edward Medical University, Lahore, 4Khyber Medical University, Peshawar, 5Department of Medicine, Karachi Medical and Dental College, Karachi, 6Dow University of Health Sciences, Karachi Pakistan, 7Dow International Medical College, Karachi Pakistan, 8Jinnah Sindh Medical University, Karachi, 9Shaikh Zayed Hospital, Lahore
Objective:
This study examined trends and disparities related to Alzheimer’s Disease (AD) and Aspiration pneumonia (AP) among elderly patients in the U.S. by gender, race, urbanization, place of death, region, and state.
Background:
AP is commonly associated with indigenous oral bacteria and hospital-acquired pathogens, especially in hospitals and nursing homes. Elderly patients with dementia, particularly AD, have nearly twice the risk of pneumonia-related mortality compared to those without dementia.
Design/Methods:
The CDC WONDER Multiple Cause of Death dataset (1999–2020) was used to analyze deaths in elderly U.S. patients (≥ 65 years) with ICD-10 codes J69 (AP) and G30 (AD). Age-adjusted mortality rates (AAMR) were calculated per 100,000 persons (95% CI) by standardizing crude mortality rates. Annual percent changes (APC) in AAMRs were analyzed using the Joinpoint regression model.
Results:
Between 1999 and 2020, 115,288 AP and AD-related deaths were reported, predominantly in nursing homes (49.3%), nearly double that in medical facilities. The overall AAMR remained stable initially, then declined from 2002 to 2020, with an average annual percentage change (AAPC) of -2.72 (95% CI: -3.24 to -2.08). Men had consistently higher AAMR than women from 1999 (AAMR men: 19.2 vs women: 13.4) to 2020 (AAMR men: 9.9 vs women: 7.7). The highest AAMR was observed in NH Whites (13), followed by Hispanic or Latinos (10.7). NH Whites and NH Blacks had significant declines (AAPC: -2.95 vs AAPC: -2.07, respectively). Mortality declined similarly in urban and rural areas. Regionally, the highest AAMR was in the West (15.3), while Rhode Island showing the highest rate among all states (2.9).
Conclusions:
AP and AD-related mortality in elderly patients has significantly declined over the last two decades. However, significant disparities were noted among men, NH White patients, and nursing home residents. This data highlights the need to identify healthcare barriers for vulnerable populations.
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