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Article type: Research Article
Authors: Lönnroos, Eijaa; b; c; * | Kyyrönen, Penttid | Bell, J. Simonb; c; e | van der Cammen, Tischa J.M.f | Hartikainen, Sirpab; c
Affiliations: [a] Institute of Public Health and Clinical Nutrition, Department of Geriatrics, University of Eastern Finland, Kuopio, Finland | [b] Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland | [c] Clinical Pharmacology and Geriatric Pharmacotherapy Unit, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland | [d] Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland | [e] Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute, University of South Australia, Adelaide, Australia | [f] Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
Correspondence: [*] Correspondence to: Eija Lönnroos, Institute of Public Health and Clinical Nutrition, Department of Geriatrics, University of Eastern Finland, FI-70211 Kuopio, Finland. Tel.: +358 40 355 2932; Fax: +358 17 162 131. E-mail: [email protected].
Abstract: Few studies have reported the risk of death related to Alzheimer's disease (AD) in large population-based cohorts. The objective of this study was to analyze the impact of AD on all-cause mortality in a nationwide sample of persons with AD. Community-dwelling persons with AD and an equal number of individually matched (age, gender, and region of residence) control persons without AD were identified from the registers of Social Insurance Institution of Finland at the end of 2005. Deaths in this sample (n = 56,041, mean age 79.7 years, 67.8% women) during a 57-month follow-up period were recorded. Using a nested case-control design, unadjusted and adjusted (cardiovascular disease, cancer, diabetes, and asthma and/or COPD) hazard ratios (HR) with 95% confidence intervals (CI) were computed using proportional hazards regression. The results were categorized according to age at death (<80, 80 to 89, ≥90 years) and duration of AD (≤3, 4 to 6, ≥7 years). The unadjusted HR for death associated with AD was 2.03 (95% CI: 1.97 to 2.09). The HR was highest in the youngest age category [HR = 3.46 (95% CI: 3.18 to 3.77)], and still significantly elevated in the oldest age category [HR = 1.50 (95% CI: 1.41 to 1.60)]. Comorbidity adjustments did not change the HRs, and even a short duration of AD (≤3 years) was associated with a significantly increased risk of death. In conclusion, AD was associated with an increased risk of death that was more pronounced at younger ages and existed even after a recent diagnosis of AD.
Keywords: Alzheimer's disease, case-control study, mortality, register-based
DOI: 10.3233/JAD-2012-120808
Journal: Journal of Alzheimer's Disease, vol. 33, no. 1, pp. 157-164, 2013
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