Kuopio Research Center of Geriatric Care, School of Pharmacy, University of Eastern Finland, P.O. Box 1627, Kuopio, 70211, Finland.
BMC Health Serv Res. 2023 Apr 4;23(1):339. doi: 10.1186/s12913-023-09345-3.
Alzheimer's disease (AD) is a major determinant of healthcare costs and increase in the healthcare service use occur already before the AD diagnosis. However, little is known how the different diagnosis categories contribute to this increase in healthcare use. We investigated how the hospitalizations and specialized healthcare outpatient visits from different diagnosis categories, based on the International Classification of Diseases (ICD-10) chapters, contribute to increased specialized healthcare service use during ten-year period preceding AD diagnosis.
A register-based nationwide cohort of 42,934 community-dwelling persons who received clinically verified AD diagnosis in between 2008 and 2011 in Finland and 1:1 age, sex and hospital district- matched comparison cohort were included. Hospitalizations and specialized healthcare visits were categorized by the main diagnosis, according to the ICD-10 chapters. AD and dementia were separated to their own category. The number of persons with visits and stays was calculated for every 6 months, irrespective of the frequency of visits/stays individual had during that time window. Furthermore, the relative distribution of the diagnosis categories was computed.
AD cohort was more likely to have visits and stays during the 10-year period (OR 1.19, 95% CI 1.17-1.21). The number of persons with visits and stays peaked in AD cohort from 1.5 years before the diagnosis when the differences in relative distribution of different diagnosis categories also became evident. The largest differences were observed for visits/stays with cognitive disorders, symptoms of unspecified diseases and psychiatric disorders diagnoses, and those with missing diagnosis codes in the last time window before AD diagnosis.
Increased healthcare service use before AD diagnosis does not seem to arise from differences in specific diagnosis categories of ICD-10 such as diseases of the circulatory system, but from the higher frequency of visits and stays among persons with AD across diagnosis categories. Based on the relative distribution of diagnosis categories, the steep increase in healthcare service use just before and during the diagnostic process is likely due to prodromal symptoms and visits related to cognition.
阿尔茨海默病（AD）是医疗保健成本的主要决定因素，并且在 AD 诊断之前就已经出现了医疗保健服务使用的增加。然而，人们对不同诊断类别如何导致医疗保健使用增加知之甚少。我们研究了基于国际疾病分类（ICD-10）章节的不同诊断类别如何导致 AD 诊断前十年期间专门医疗保健服务使用的增加。
该研究纳入了一个基于登记的全国队列，其中包括 42934 名居住在社区的人，他们在芬兰于 2008 年至 2011 年间接受了临床确诊的 AD 诊断，同时还纳入了 1：1 年龄、性别和医院区匹配的对照组。根据 ICD-10 章节，将住院和专门医疗保健就诊按主要诊断进行分类。将 AD 和痴呆分开到自己的类别中。无论个体在该时间段内就诊的频率如何，每 6 个月计算一次就诊人数。此外，还计算了诊断类别的相对分布。
AD 队列在 10 年期间更有可能就诊和住院（OR 1.19，95%CI 1.17-1.21）。在 AD 队列中，从诊断前 1.5 年开始，就诊和住院人数达到峰值，此时不同诊断类别的相对分布差异也变得明显。在 AD 诊断前的最后一个时间窗口中，观察到最大的差异是与认知障碍、未指明疾病和精神障碍诊断相关的就诊/住院以及诊断代码缺失的就诊/住院。
AD 诊断前医疗保健服务使用的增加似乎不是由于 ICD-10 特定诊断类别的差异引起的，例如循环系统疾病，而是由于 AD 患者在各诊断类别中就诊和住院的频率更高。基于诊断类别的相对分布，在诊断过程前后医疗保健服务使用的急剧增加很可能是由于前驱症状和与认知相关的就诊。
