Association Between Neuroticism and Dementia on Healthcare Use: A Multi-Level Analysis Across 27 Countries from The Survey of Health, Ageing and Retirement in Europe (SHARE)

Article type: Research Article

Authors: Ruiz-Adame, Manuel^{a; b; *} | Ibañez, Agustín^{c; d; e; f} | Mollayeva, Tatyana^{g; h; i; j} | Trépel, Dominic^{b; k}

Affiliations: [a] Applied Economic Department, University of Granada, Campus of Melilla, Melilla, Spain | [b] Trépel Laboratory, Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland | [c] Latin American Brain Health Institute, Universidad Adolfo Ibanez, Santiago, Chile | [d] Cognitive Neuroscience Center & CONICET, Universidad de San Andres, Buenos Aires, Argentina | [e] Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA | [f] Predictive Brain Health Modelling, Trinity College Dublin, Dublin, Ireland | [g] Dalla Lana School of Public Health, Toronto, Canada | [h] Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada | [i] KITE Research Institute, Toronto Rehab, University Health Network, Toronto, Canada | [j] Global Brain Health Institute (GBHI), Trinity College Dublin, Dublin, Ireland | [k] Trinity College Dublin, Dublin, Ireland

Correspondence: [*] Correspondence to: Manuel Ruiz-Adame, PhD, Lecturer, University of Granada, Spain; Department of Applied Economics, Campus of Melilla. Melilla, Spain. Tel.: +34 609 67 04 29; E-mail: [email protected]; ORCID: 0000-0003-0899-6087

Abstract: Background:People with high levels of neuroticism are greater users of health services. Similarly, people with dementia have a higher risk of hospitalization and medical visits. As a result, dementia and a high level of neuroticism increase healthcare use (HCU). However, how these joint factors impact the HCU at the population level is unknown. Similarly, no previous study has assessed the degree of generalization of such impacts, considering relevant variables including age, gender, socioeconomic, and country-level variability. Objective:To examine how neuroticism and dementia interact in the HCU. Methods:A cross-sectional study was performed on a sample of 76,561 people (2.4% with dementia) from 27 European countries and Israel. Data were analyzed with six steps multilevel non-binomial regression modeling, a statistical method that accounts for correlation in the data taken within the same participant. Results:Both dementia (Incidence Rate Ratio (IRR): 1.537; α= 0.000) and neuroticism (IRR: 1.122; α= 0.000) increased the HCU. The effect of having dementia and the level of neuroticism increased the HCU: around 53.67% for the case of having dementia, and 12.05% for each increment in the level of neuroticism. Conversely, high levels of neuroticism in dementia decreased HCU (IRR: 0.962; α= 0.073). These results remained robust when controlling for age, gender, socioeconomic, and country-levels effects. Conclusion:Contrary to previous findings, neuroticism trait in people with dementia decreases the HCU across sociodemographic, socioeconomic, and country heterogeneity. These results, which take into account this personality trait among people with dementia, are relevant for the planning of health and social services.

Keywords: Alzheimer’s disease, dementia, health care use, health economics, neuroticism, personality traits

DOI: 10.3233/JAD-230265

Journal: Journal of Alzheimer's Disease, vol. 95, no. 1, pp. 181-193, 2023