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Liu CC, Liu CH, Chang KC, Ko MC, Lee PC, Wang JY. Association Between Young-Onset Dementia and Risk of Hospitalization for Motor Vehicle Crash Injury in Taiwan. JAMA Netw Open 2022; 5:e2210474. [PMID: 35511178 PMCID: PMC9073564 DOI: 10.1001/jamanetworkopen.2022.10474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
IMPORTANCE Several studies have suggested that older-onset dementia is associated with an increased risk of motor vehicle crash injury (MVCI). However, evidence of an association between young-onset dementia and the risk of MVCI is insufficient, particularly in Asia. OBJECTIVE To investigate the association between young-onset dementia and MVCI-related hospitalization in Taiwan. DESIGN, SETTING, AND PARTICIPANTS In this nationwide, population-based cohort study in Taiwan, a cohort of 39 344 patients aged 40 to 64 years with incident dementia diagnosed between 2006 and 2012 was matched 1:1 with a cohort of participants without dementia by age, sex, and index year (initial diagnosis of dementia). Participants were identified from Taiwan's National Health Insurance Research Database (NHIRD). Data were analyzed between March 25 and October 22, 2021. EXPOSURES Dementia, defined by International Classification of Diseases, Ninth Revision, Clinical Modification codes. MAIN OUTCOMES AND MEASURES Hospitalization for MVCI, determined using linked data from Taiwan's Police-Reported Traffic Accident Registry and the NHIRD from January 1, 2003, to December 31, 2015. Hazard ratios (HRs) for MVCI-related hospitalization were estimated using Cox proportional hazards regression models adjusted for sex, age, salary-based insurance premium, urbanization level, and comorbidities. RESULTS Of the 78 688 participants, 47 034 (59.8%) were male; the mean (SD) age was 54.5 (7.4) years. During the 10-year follow-up period, the incidence density of MVCI-related hospitalization was 45.58 per 10 000 person-years (95% CI, 42.77-48.39 per 10 000 person-years) among participants with dementia and 24.10 per 10 000 person-years (95% CI, 22.22-25.99 per 10 000 person-years) among participants without dementia. Compared with participants without dementia, patients with young-onset dementia were at higher risk of MVCI-related hospitalization (adjusted HR [aHR], 1.83; 95% CI, 1.63-2.06), especially those in younger age groups (aged 40-44 years: aHR, 3.54; 95% CI, 2.48-5.07) and within a shorter period (within 1 year of follow-up: aHR, 3.53; 95% CI, 2.50-4.98) after dementia was diagnosed. Patients with young-onset dementia also had a higher risk of being a pedestrian when the crash occurred (aHR, 2.89; 95% CI, 2.04-4.11), having an intracranial or internal injury (aHR, 2.44; 95% CI, 2.02-2.94), and having a severe injury (aHR, 2.90; 95% CI, 2.16-3.89). CONCLUSIONS AND RELEVANCE In this retrospective cohort study, patients in Taiwan with a diagnosis of young-onset dementia had a higher risk of MVCI-related hospitalization than did individuals without dementia and the risk varied by age, disease duration, transport mode, injury type, and injury severity. These findings suggest a need for the planning of strategies to prevent transportation crashes among patients with young-onset dementia.
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Affiliation(s)
- Chih-Ching Liu
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Chien-Hui Liu
- School of Nursing, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Kun-Chia Chang
- Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan
- Department of Natural Biotechnology, NanHua University, Chiayi, Taiwan
| | - Ming-Chung Ko
- Department of Surgery, Zhong-Xing Branch, Taipei City Hospital, Taipei, Taiwan
| | - Pei-Chen Lee
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Jiun-Yi Wang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
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Chen R, Chien WC, Kao CC, Chung CH, Liu D, Chiu HL, Chou KR. Analysis of the risk and risk factors for injury in people with and without dementia: a 14-year, retrospective, matched cohort study. Alzheimers Res Ther 2018; 10:111. [PMID: 30376887 PMCID: PMC6208020 DOI: 10.1186/s13195-018-0437-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 10/10/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Most previous studies on dementia and injuries have focused on a particular type of injury, and few studies have investigated overall injury in people with dementia. In this study, we investigated the risk factors and risk of overall injury, including the diagnosis, cause, and intentionality of injury, in people with and without dementia in Taiwan. METHODS We collected relevant data between 2000 and 2013 from the National Health Insurance Research Database (NHIRD). Overall, 455,630 cases, consisting of 91,126 people with dementia and 364,504 people without dementia, were included in this study and we performed subgroup analysis. A multivariate Cox proportional hazards regression analysis was used to determine the risk of injuries. RESULTS The 14-year follow-up data showed that people with dementia had a higher risk of injury-related hospitalization than did people without dementia (19.92% vs 18.86%, hazard ratio (HR) = 1.070, p < 0.001). Regarding the cause of injury, people with dementia were more likely to be hospitalized due to suffocation (HR = 2.301, p < 0.001), accidental drug poisoning (HR = 1.485, p < 0.001), or falls (HR = 1.076, p < 0.001), and were less likely to be hospitalized due to suicide or self-inflicted injury (HR = 0.670, p < 0.001) or a traffic accident (HR = 0.510, p < 0.001) than were people without dementia. Subgroup analysis showed that people with dementia with any of the three subtypes of dementia were at a higher risk of homicide or abuse than were people without dementia (vascular dementia, HR = 2.079, p < 0.001; Alzheimer's disease, HR = 1.156, p < 0.001; other dementia, HR = 1.421, p < 0.001). The risk factors for overall injury included dementia diagnosis, female gender, age 65-74 years, and seeking medical attention for an injury within the past year. CONCLUSION People with dementia are at a higher risk of injury-related hospitalization than people without dementia. The results of this study provide a reference for preventing suffocation, drug poisoning, and falls in people with dementia. In addition, government agencies should pay attention to and intervene in cases of abuse suffered by people with dementia.
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Affiliation(s)
- Ruey Chen
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, No.291, Zhongzheng Rd., Zhonghe District, Taipei, 23561 Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, No.250, Wu-Hsing Street, Taipei, 11031 Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, No.325, Section 2, Cheng-Kung Road, Neihu District, Taipei, 11490 Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, No.161, Section 6, Min-Chuan East Road, Neihu District, Taipei, 11490 Taiwan
- School of Public Health, National Defense Medical Center, No.161, Section 6, Min-Chuan East Road, Neihu District, Taipei, 11490 Taiwan
| | - Ching-Chiu Kao
- School of Nursing, College of Nursing, Taipei Medical University, No.250, Wu-Hsing Street, Taipei, 11031 Taiwan
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, No.111, Sec. 3, Xinglong Rd., Taipei, 11696 Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, No.161, Section 6, Min-Chuan East Road, Neihu District, Taipei, 11490 Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, Taiwan
| | - Doresses Liu
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, No.111, Sec. 3, Xinglong Rd., Taipei, 11696 Taiwan
| | - Huei-Ling Chiu
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, No.250, Wu-Hsing Street, Taipei, 11031 Taiwan
| | - Kuei-Ru Chou
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, No.291, Zhongzheng Rd., Zhonghe District, Taipei, 23561 Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, No.250, Wu-Hsing Street, Taipei, 11031 Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, No.252, Wuxing St, Xinyi District, Taipei, 110 Taiwan
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Petersen JD, Siersma VD, Christensen RD, Storsveen MM, Nielsen CT, Waldorff FB. The risk of fall accidents for home dwellers with dementia-A register- and population-based case-control study. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2018; 10:421-428. [PMID: 30151421 PMCID: PMC6107894 DOI: 10.1016/j.dadm.2018.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction Institutionalized people with dementia have an increased risk of fall accidents, but little is known about whether this increased risk holds for home dwellers. Methods This register- and population-based study comprised 115,584 cases and 394,679 controls. Cases were individuals with any fall between 2009 and 2014, and matched with up to six controls on age, sex, and geographic location. Individuals were excluded if they (1) had any fall in 2008, or (2) lived in a nursing home on the date of the fall. Dementia, other chronic diseases, and sedative medicines were assessed from Danish national registers. Results After adjusting for potential confounders, older people with dementia living at home had a 1.89-fold higher risk of fall (odds ratio = 1.89, 95% confidence interval [1.84–1.94], P < .001). Discussion Dementia almost doubles the risk of fall for older Danish people living at home. This highlights the need for effective fall preventions that target people with dementia.
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Affiliation(s)
- Jindong Ding Petersen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
- Mental Health Services in the Region of Southern Denmark, Department of Mental Health, Kolding-Vejle, Denmark
- Corresponding author. Tel.: +45 6550 9531; Fax: +45 6591 8296.
| | - Volkert Dirk Siersma
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - René dePont Christensen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Maria Munch Storsveen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Connie Thurøe Nielsen
- Mental Health Services in the Region of Southern Denmark, Department of Mental Health, Kolding-Vejle, Denmark
| | - Frans Boch Waldorff
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
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Petersen JD, Siersma VD, Depont Christensen R, Storsveen MM, Nielsen CT, Vass M, Waldorff FB. Dementia and road traffic accidents among non-institutionalized older people in Denmark: A Danish register-based nested case-control study. Scand J Public Health 2018; 47:221-228. [PMID: 29914317 DOI: 10.1177/1403494818782094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM We used register-based data to estimate the effect of all-type dementia on road traffic accidents (RTAs) risk, combined with comorbidities or sedative medicines, among non-institutionalized older people in Denmark. METHODS The source population was all residents in Denmark aged 65 years and older, alive as of January 1, 2008 ( n = 853,228). Cases were those who had any type of RTA in 2009-2014. Each case was matched for age, sex and geographic location to 4-6 controls. All-type dementia was ascertained using the International Classification of Diseases version 10 (ICD-10) diagnosis supplemented with prescribed medicine records. Eight chronic diseases were selected to assess comorbidities. Four types of medicines were categorized as sedative medicines for analysis. Conditional logistic regression with adjustment for education and marital status as well as either the number of comorbidities or sedative medications use was performed using STATA software. RESULTS Older people with dementia had lower RTAs risk compared to their controls (odds ratio = 0.43, 95% confidence interval (0.32-0.60), p < 0.001). Significant interaction was observed between dementia and the number of comorbidities for RTAs estimation. CONCLUSIONS The significantly lower RTAs risk for older individuals with dementia observed in our study may be due to people with dementia living at home having a lower frequency of outdoor activities; that is, less exposure to traffic. However, this, together with the interaction between dementia and comorbidities as well as sedative medications, should be investigated further.
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Affiliation(s)
- Jindong Ding Petersen
- 1 Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,2 Department of Mental Health Vejle, Mental Health Services in the Region of Southern Denmark, Vejle, Denmark
| | - Volkert Dirk Siersma
- 3 Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - René Depont Christensen
- 1 Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Maria Munch Storsveen
- 1 Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Connie Thurøe Nielsen
- 2 Department of Mental Health Vejle, Mental Health Services in the Region of Southern Denmark, Vejle, Denmark
| | - Mikkel Vass
- 3 Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Frans Boch Waldorff
- 1 Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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