University of Maryland School of Medicine.
University of Maryland School of Pharmacy, Baltimore, MD.
Alzheimer Dis Assoc Disord. 2018 Oct-Dec;32(4):326-332. doi: 10.1097/WAD.0000000000000277.
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.
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.
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.
Variation in HCU by ADRD subtype points to different pathways to diagnosis and patterns of use.
先前的研究报告称，在阿尔茨海默病和相关痴呆症（ADRD）诊断之前，医疗保健利用率（HCU）较高，但没有研究评估ADRD 亚型之间的 HCU 差异或检查特定疾病的 HCU。本研究的目的是确定 ADRD 亚型，并：（1）描述诊断前 3 年所有原因和（2）特定疾病的 HCU；（3）确定 HCU 是否因 ADRD 亚型而异。
我们使用了 OptumLabs Data Warehouse 2008 年至 2014 年的数据，使用基于诊断和提供者类型时间序列的算法来确定 ADRD 亚型（总 N=36838）。在 ADRD 诊断前 3 年内，每年所有原因和特定疾病 HCU 的计数回归到 ADRD 亚型，其中轻度认知障碍（MCI）为参考组，年份和其他变量。
HCU 随时间增加，在门诊环境中最高，并且因 ADRD 亚型而异。与 MCI 相比，血管性和非特异性痴呆症的 HCU 最高。与 MCI 相比，大多数亚型的特定疾病 HCU 升高。
ADRD 亚型之间 HCU 的差异表明了不同的诊断途径和使用模式。
