Hospitalization Patterns and Risk Factors in Adults with Alzheimer's Disease and Related Dementias (ADRD) with and Without Epilepsy: A Multi-state Cohort Study
Sanika Joshi1, Rose Rasty1, Megan Hsu1, Marlon Coelho1, Harrison Clement3, Kylie Getz3, Brad Kamitaki2
1Rutgers Robert Wood Johnson Medical School, 2Department of Neurology, Rutgers Robert Wood Johnson Medical School, 3Rutgers School of Public Health
Objective:
This study aims to identify and compare hospitalization patterns in patients with Alzheimer’s Disease and Related Dementias (ADRD) with and without epilepsy.
Background:
Current evidence points to a bi-directional relationship between epilepsy and ADRD, with both conditions increasing risks of hospitalization. However, comprehensive information on hospitalization patterns and risk factors in patients with co-morbid ADRD and epilepsy remains limited.
Design/Methods:
We analyzed Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) hospitalizations between 2016-2018 in four US states (New York, Wisconsin, Maryland, Florida) for patients aged > 65 years with ADRD (any hospitalization with an ADRD diagnosis code, n = 707,531) and ADRD+epilepsy (any hospitalization with an ADRD and epilepsy [G40] diagnosis codes, n = 43,209). We modeled inpatient hospitalization rates using negative binomial regression, adjusting for demographics, insurance status, income quartile, sex, state of residence, and Elixhauser co-morbidity index. We also examined length of stay (LOS) as a secondary outcome.
Results:
Patients with ADRD+epilepsy demonstrated significantly higher hospitalization rates (rate ratio [RR] 1.10, 95% CI: 1.08-1.12), with more annual hospital visits (1.5 per year, versus 1.4 for ADRD alone, p < 0.0001). The ADRD+epilepsy group had a longer mean LOS (7.8 versus 6.6 days, p < 0.0001) compared with admissions in patients with ADRD alone. Racial disparities were striking, with Black patients representing 23.6% of the ADRD+epilepsy cohort versus 12.6% of ADRD alone (p < 0.0001). Black patients also experienced high rates of hospitalization (RR 1.24, 95% CI: 1.23-1.25) versus White patients. Hispanic/Latino patients (RR 1.22, 95% CI: 1.21-1.23) and Native American patients (RR 1.24, 95% CI: 1.09-1.41) also had increased hospitalization rates.
Conclusions:
Co-morbid epilepsy significantly increases inpatient hospitalization rates for those with ADRD, with especially pronounced disparities among racially minoritized groups. These findings underscore the need for targeted coordination of care and preventive interventions for higher risk ADRD patients with epilepsy.
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