Saunders Milda R, Qi Mingyu, Huang Elbert S, Konetzka R Tamara
Section of General Internal Medicine, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA.
Center for Chronic Disease Research and Policy, University of Chicago Medicine, Chicago, IL, USA.
J Gen Intern Med. 2025 Jan 14. doi: 10.1007/s11606-024-09069-y.
Little is known about the population of Medicare beneficiaries with both chronic kidney disease (CKD) and Alzheimer's disease and related dementias (ADRD).
Using data from Medicare fee-for-service (FFS) beneficiaries aged 65 and over identified through 2011-2019 Master Beneficiary Summary File (MBSF), we estimated the size, growth, and racial-ethnic characteristics of the ADRD and CKD populations. Individuals were classified as having ADRD and CKD based on CMS Chronic Conditions Data Warehouse (CCW) indicators in the MBSF Chronic Conditions file.
Among FFS beneficiaries, the prevalence of CKD has increased from 17.5% in 2011 to 27.9% in 2019, and the prevalence of ADRD has decreased over that time from 13.3 to 12.5%. The prevalence of individuals with co-morbid ADRD and CKD has risen from 4.4 to 6.3% which represents 1.72 million older adults. Black and Hispanic individuals have the highest prevalence of co-morbid CKD and ADRD, averaging 10.0% and 9.0% in 2019, respectively, compared to other racial-ethnic groups (≤ 7.2% all others). In addition, among those previously diagnosed with ADRD, the proportion with co-morbid CKD has been steadily increasing from 25.5% in 2011 to 44.4% in 2019. While the proportion of individuals with ADRD who have co-morbid CKD has increased across all race-ethnicities, it is highest in Black and Hispanic individuals (56.7 and 51%, respectively in 2019).
CONCLUSION/RELEVANCE: The prevalence of Medicare FFS enrollees with both ADRD and CKD is increasing. Although the ADRD prevalence has declined, there is a rising number of individuals with CKD who are diagnosed with ADRD and a rising proportion of those with ADRD who also have CKD. Due to shared clinical and demographic risk factors, interventions to reduce CKD progression could also delay ADRD onset. In patients with both advanced ADRD and advanced CKD, clinicians and policymakers should focus on treatment options that consider both co-morbidities.
对于同时患有慢性肾脏病（CKD）和阿尔茨海默病及相关痴呆症（ADRD）的医疗保险受益人群，我们所知甚少。
利用2011 - 2019年医疗保险服务收费（FFS）受益人的数据，这些数据来自于医疗保险主受益人汇总文件（MBSF）中65岁及以上的老年人，我们估算了患有ADRD和CKD人群的规模、增长情况以及种族特征。根据MBSF慢性病文件中的医疗保险和医疗补助服务中心（CMS）慢性病数据仓库（CCW）指标，将个体分类为患有ADRD和CKD。
在FFS受益人中，CKD的患病率从2011年的17.5%上升至2019年的27.9%，而ADRD的患病率在这段时间内从13.3%降至12.5%。患有ADRD和CKD合并症的个体患病率从4.4%上升至6.3%，这代表了172万老年人。黑人和西班牙裔个体患有CKD和ADRD合并症的患病率最高，2019年分别平均为10.0%和9.0%，相比其他种族群体（所有其他群体≤7.2%）。此外，在那些先前被诊断为ADRD的个体中，患有CKD合并症的比例从2011年的25.5%稳步上升至2019年的44.4%。虽然患有ADRD且患有CKD合并症的个体比例在所有种族群体中均有所增加，但黑人和西班牙裔个体中的这一比例最高（2019年分别为56.7%和51%）。
结论/意义：同时患有ADRD和CKD的医疗保险FFS参保者患病率正在上升。尽管ADRD患病率有所下降，但被诊断患有ADRD的CKD患者数量在增加，且患有ADRD同时也患有CKD的患者比例也在上升。由于存在共同的临床和人口统计学风险因素，减少CKD进展的干预措施也可能延迟ADRD的发病。对于同时患有晚期ADRD和晚期CKD的患者，临床医生和政策制定者应关注同时考虑两种合并症的治疗方案。
