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Increased Health Care Utilization in Dementia Subtypes Before Diagnosis

Albrecht, Jennifer S., PhD*; Hanna, Maya, MPH; Kim, Dure, PharmD; Perfetto, Eleanor M., PhD, MS†,‡,§

Alzheimer Disease & Associated Disorders: October-December 2018 - Volume 32 - Issue 4 - p 326–332
doi: 10.1097/WAD.0000000000000277
Original Articles

Introduction: Prior studies have reported higher health care utilization (HCU) leading up to diagnosis of the Alzheimer disease and related dementia (ADRD), but none have assessed variation in HCU by ADRD subtype or examined disease-specific HCU. The objectives of this study were to identify ADRD subtypes and: (1) characterize all-cause and (2) disease-specific HCU during the 3 years preceding diagnosis, and (3) determine if HCU varied by ADRD subtype.

Methods: We used data from the OptumLabs Data Warehouse 2008 to 2014 to identify ADRD subtypes (total N=36,838) using an algorithm based on temporal sequencing of diagnoses and provider type. Annual counts of all-cause and disease-specific HCU in each of the 3 years preceding ADRD diagnosis were regressed on ADRD subtypes with mild cognitive impairment (MCI) as the reference group, year, and other variables.

Results: HCU increased over time, was highest in the outpatient setting, and varied by ADRD subtype. Compared with MCI, highest HCU was observed in vascular and nonspecific dementia. Compared with MCI, most subtypes had elevated disease-specific HCU.

Discussion: Variation in HCU by ADRD subtype points to different pathways to diagnosis and patterns of use.

*University of Maryland School of Medicine

University of Maryland School of Pharmacy, Baltimore, MD

National Health Council, Washington, DC

§OptumLabs, Visiting Fellow, Cambridge, MA

Supported by AstraZeneca, Global CEO Initiative, Jansen and OptumLabs, and Roche. J.S.A. was supported by Agency for Healthcare Research and Quality grant K01HS024560.

For the full list of members and sponsors, please see

J.S.A., M.H., D.K., and E.M.P. all made substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data; drafting the article and revising it critically for important intellectual content; and final approval of the version to be published.

E.M.P. is employed by the National Health Council in Washington, DC, which accepts membership dues and sponsorships from a variety of organizations and companies. The remaining authors declare no conflicts of interest.

Reprints: Jennifer S. Albrecht, PhD, Department of Epidemiology and Public Health, University of Maryland School of Medicine, MSTF 334C, 10 S. Pine St., Baltimore, MD 21201 (e-mail:

Received February 22, 2018

Accepted August 30, 2018

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