| Multimorbidity Pattern and Risk for Mortality Among Patients With Dementia: A Nationwide Cohort Study Using Latent Class Analysis |
Che-Sheng Chu1,2,3,4 
, Shu-Li Cheng5
, Ya-Mei Bai6,7
, Tung-Ping Su6,7,8
, Shih-Jen Tsai6,7
, Tzeng-Ji Chen8,9,10
, Fu-Chi Yang11
, Mu-Hong Chen6,7
, Chih-Sung Liang12,13
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1Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
2Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
3Non-Invasive Neuromodulation Consortium for Mental Disorders, Society of Psychophysiology, Taipei, Taiwan
4Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
5Department of Nursing, Mackay Medical College, Taipei, Taiwan
6Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
7Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
8Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan
9Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
10Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
11Department of Neurology, Tri-Service General Hospital, Taipei, Taiwan
12Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan
13Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan |
Correspondence: Mu-Hong Chen ,Tel: +886-2-28344012, Email: kremer7119@gmail.com
Correspondence: Chih-Sung Liang ,Tel: +886-2-2895-9808, Fax: +886-222895-7633, Email: lcsyfw@gmail.com
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Received: April 12, 2023 Revised: June 16, 2023 Accepted: June 28, 2023 Published online: September 19, 2023
*Che-Sheng Chu and Shu-Li Cheng contributed equally to this study as co-first authors. |
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| Abstract |
Objective
Individuals with dementia are at a substantially elevated risk for mortality; however, few studies have examined multimorbidity patterns and determined the inter-relationship between these comorbidities in predicting mortality risk.
Methods
This is a prospective cohort study. Data from 6,556 patients who were diagnosed with dementia between 1997 and 2012 using the Taiwan National Health Insurance Research Database were analyzed. Latent class analysis was performed using 16 common chronic conditions to identify mortality risk among potentially different latent classes. Logistic regression was performed to determine the adjusted association of the determined latent classes with the 5-year mortality rate.
Results
With adjustment for age, a three-class model was identified, with 42.7% of participants classified as “low comorbidity class (cluster 1)”, 44.2% as “cardiometabolic multimorbidity class (cluster 2)”, and 13.1% as “FRINGED class (cluster 3, characterized by FRacture, Infection, NasoGastric feeding, and bleEDing over upper gastrointestinal tract).” The incidence of 5-year mortality was 17.6% in cluster 1, 26.7% in cluster 2, and 59.6% in cluster 3. Compared with cluster 1, the odds ratio for mortality was 9.828 (95% confidence interval [CI]=6.708–14.401; p<0.001) in cluster 2 and 1.582 (95% CI=1.281–1.953; p<0.001) in cluster 3.
Conclusion
Among patients with dementia, the risk for 5-year mortality was highest in the subpopulation characterized by fracture, urinary and pulmonary infection, upper gastrointestinal bleeding, and nasogastric intubation, rather than cancer or cardiometabolic comorbidities. These findings may improve decision-making and advance care planning for patients with dementia. |
| Key words
Dementia; Latent class analysis; Mortality; Multimorbidity |
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