Analysis of dementia in the US population using Medicare claims: Insights from linked survey and administrative claims data

Chen, Yi; Tysinger, Bryan; Crimmins, Eileen M.; Zissimopoulos, Julie

doi:10.1016/j.trci.2019.04.003

Cited by 84 publications

(135 citation statements)

References 50 publications

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“…These results are generally consistent with recent, related work, which also found overall and race-specific differences in who is identified as having dementia when using ADAMS, L.-K.-W., and Medicare claims to identify persons with dementia [25,26]. However, here we took a more comprehensive approach, considering 9 different classification strategies and also considering how the use of different algorithms impacts risk factor associations.…”

Section: Discussion/conclusionsupporting

confidence: 89%

Implications of the Use of Algorithmic Diagnoses or Medicare Claims to Ascertain Dementia

2020

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Introduction: Formal dementia ascertainment with research criteria is resource-intensive, prompting the growing use of alternative approaches. Our objective was to illustrate the potential bias and implications for study conclusions introduced through the use of alternate dementia ascertainment approaches. Methods: We compared dementia prevalence and risk factor associations obtained using criterion-standard dementia diagnoses to those obtained using algorithmic or Medicare-based dementia ascertainment in participants of the baseline visit of the Aging, Demographics, and Memory Study (ADAMS), a Health and Retirement Study (HRS) sub-study. Results: Estimates of dementia prevalence derived using algorithmic or Medicare-based ascertainment differ substantially from those obtained using criterion-standard ascertainment. Use of algorithmic or Medicare-based dementia ascertainment can, but does not always, lead to risk factor associations that substantially differ from those obtained using criterion-standard ascertainment. Discussion/Conclusions: Absolute estimates of dementia prevalence should rely on samples with formal dementia ascertainment. The use of multiple algorithms is recommended for risk factor studies when formal dementia ascertainment is not available.

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Section: Discussion/conclusionsupporting

confidence: 89%

Implications of the Use of Algorithmic Diagnoses or Medicare Claims to Ascertain Dementia

2020

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“…Depending on the data source, there can be vastly different prevalence and incidence estimates. For instance, the Health and Retirement Study linked to Medicare administrative claims data has shown that cognitive test results from survey data vs diagnoses from claims data can yield different incidence for dementia . For example, among whites, incidence of dementia based on cognitive tests from surveys was lower than that using diagnosis codes from claims (3.2% vs 12.3%) .…”

Section: Discussionmentioning

confidence: 99%

“…For instance, the Health and Retirement Study linked to Medicare administrative claims data has shown that cognitive test results from survey data vs diagnoses from claims data can yield different incidence for dementia . For example, among whites, incidence of dementia based on cognitive tests from surveys was lower than that using diagnosis codes from claims (3.2% vs 12.3%) . In contrast, among blacks, dementia incidence was higher using cognitive tests compared to that using diagnosis codes (15.2% vs 11.1%) …”

Section: Discussionmentioning

confidence: 99%

Can Hearing Aids Delay Time to Diagnosis of Dementia, Depression, or Falls in Older Adults?

Mahmoudi

Basu

Langa

et al. 2019

J American Geriatrics Society

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OBJECTIVE To examine the association between hearing aids (HAs) and time to diagnosis of Alzheimer disease (AD) or dementia, anxiety or depression, and injurious falls among adults, aged 66 years and older, within 3 years of hearing loss (HL) diagnosis. DESIGN Retrospective cohort study. SETTING We used 2008 to 2016 national longitudinal claims data (based on office visit, inpatient, or outpatient healthcare encounters) from a large private payer. We used Kaplan‐Meier curves to examine unadjusted disease‐free survival and crude and adjusted Cox regression models to examine associations between HAs and time to diagnosis of three age‐related/HL‐associated conditions within 3 years of HL diagnosis. All models were adjusted for age, sex, race/ethnicity, census divisions, and prior diagnosis of cardiovascular conditions, hypertension, hypercholesterolemia, obesity, and diabetes. PARTICIPANTS The participants included 114 862 adults, aged 66 years and older, diagnosed with HL. MEASUREMENT Diagnosis of (1) AD or dementia; (2) depression or anxiety; and (3) injurious falls. INTERVENTION Use of HAs. RESULTS Large sex and racial/ethnic differences exist in HA use. Approximately 11.3% of women vs 13.3% of men used HAs (95% confidence interval [CI] difference = −0.024 to −0.016). Approximately 13.6% of whites (95% CI = 0.13‐0.14) vs 9.8% of blacks (95% CI = 0.09‐0.11) and 6.5% of Hispanics (95% CI = 0.06‐0.07) used HAs. The risk‐adjusted hazard ratios of being diagnosed with AD/dementia, anxiety/depression, and injurious falls within 3 years after HL diagnosis, for those who used HAs vs those who did not, were 0.82 (95% CI = 0.76‐0.89), 0.89 (95% CI = 0.86‐0.93), and 0.87 (95% CI = 0.80‐0.95), respectively. CONCLUSIONS Use of HAs is associated with delayed diagnosis of AD, dementia, depression, anxiety, and injurious falls among older adults with HL. Although we have shown an association between use of HAs and reduced risk of physical and mental decline, randomized trials are needed to determine whether, and to what extent, the relationship is causal. J Am Geriatr Soc 67:2362–2369, 2019

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“…Much of our understanding about the characteristics of people with AD/ADRD diagnoses who are receiving health care is based on data from Medicare fee‐for‐service and nationally representative surveys. These studies estimate the prevalence of diagnosed AD/ADRD in the United States to be 7% to 14% 6‐11 . Yet, one‐third of Medicare beneficiaries are enrolled in MA plans 12 .…”

Section: Introductionmentioning

confidence: 99%

Diagnosed prevalence of Alzheimer's disease and related dementias in Medicare Advantage plans

Jutkowitz

Bynum

Mitchell

et al. 2020

Alzheimer's & Dementia: Diagnosis, Assessment &

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Introduction One‐third of Medicare beneficiaries are enrolled in Medicare Advantage (MA). Yet, little is known about MA beneficiaries diagnosed with Alzheimer's disease (AD) and AD‐related dementias (AD/ADRD). Methods We calculated the prevalence of AD/ADRD diagnoses in 2014 and 2016 in three MA plans. We determined the demographic characteristics of beneficiaries diagnosed with AD/ADRD, and whether they disenrolled from the MA plan for any reason within 364 days from the index date. Results In 2014 and 2016, the overall prevalence of AD/ADRD diagnoses was 5.6% and 6.5%, respectively. In 2016, AD/ADRD beneficiaries were on average 82.4 (SD = 7.4) years of age, 61.8% female, and had multiple comorbidities. By 364 days post‐index date, 32% of beneficiaries with AD/ADRD had disenrolled from their plan. The demographic characteristics of 2014 beneficiaries with diagnosed AD/ADRD were similar to their 2016 counterparts. Discussion The prevalence of AD/ADRD diagnosis in MA is lower than rates reported in Medicare fee‐for‐service.

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Analysis of dementia in the US population using Medicare claims: Insights from linked survey and administrative claims data

Cited by 84 publications

References 50 publications

Implications of the Use of Algorithmic Diagnoses or Medicare Claims to Ascertain Dementia

Implications of the Use of Algorithmic Diagnoses or Medicare Claims to Ascertain Dementia

Can Hearing Aids Delay Time to Diagnosis of Dementia, Depression, or Falls in Older Adults?

Diagnosed prevalence of Alzheimer's disease and related dementias in Medicare Advantage plans

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