Temporal trend in dementia incidence since 2002 and projections for prevalence in England and Wales to 2040: modelling study

Abstract

Objective To forecast dementia prevalence with a dynamic modelling approach that integrates calendar trends in dementia incidence with those for mortality and cardiovascular disease.Design Modelling study.Setting General adult population of England and Wales.Participants The English Longitudinal Study of Ageing (ELSA) is a representative panel study with six waves of data across 2002-13. Men and women aged 50 or more years, selected randomly, and their cohabiting partners were recruited to the first wave of ELSA (2002-03). 11392 adults participated (response rate 67%). To maintain representativeness, refreshment participants were recruited to the study at subsequent waves. The total analytical sample constituted 17 906 people. Constant objective criteria based on cognitive and functional impairment were used to ascertain dementia cases at each wave.Main outcome measures To estimate calendar trends in dementia incidence, correcting for bias due to loss to follow-up of study participants, a joint model of longitudinal and time-to-event data was fitted to ELSA data. To forecast future dementia prevalence, the probabilistic Markov model IMPACT-BAM (IMPACT-Better Ageing Model) was developed. IMPACT-BAM models transitions of the population aged 35 or more years through states of cardiovascular disease, cognitive and functional impairment, and dementia, to death. It enables prediction of dementia prevalence while accounting for the growing pool of susceptible people as a result of increased life expectancy and the competing effects due to changes in mortality, and incidence of cardiovascular disease.Results In ELSA, dementia incidence was estimated at 14.3 per 1000 person years in men and 17.0/1000 person years in women aged 50 or more in 2010. Dementia incidence declined at a relative rate of 2.7% (95% confidence interval 2.4% to 2.9%) for each year during 2002-13. Using IMPACT-BAM, we estimated there were approximately 767 000 (95% uncertainty interval 735 000 to 797 000) people with dementia in England and Wales in 2016. Despite the decrease in incidence and age specific prevalence, the number of people with dementia is projected to increase to 872 000, 1 092 000, and 1 205 000 in 2020, 2030, and 2040, respectively. A sensitivity analysis without the incidence decline gave a much larger projected growth, of more than 1.9 million people with dementia in 2040.Conclusions Age specific dementia incidence is declining. The number of people with dementia in England and Wales is likely to increase by 57% from 2016 to 2040. This increase is mainly driven by improved life expectancy.

Fig 1 IMPACT-Better Ageing Model (IMPACT-BAM). Numbers represent different health states and mortality. Population vector represents the number of men and women reaching age 35 and entering the model at each calendar year. States 6 and 7 represent dementia. States 5, 6, 7, and 8 represent functional impairment or disability

Fig 2 Projected number of people with dementia in England and Wales 2011-40. Thinner lines represent 95% uncertainty intervals

Fig 3 Age specific estimated number of cases of dementia 2010-40 in men and women

Fig 4 Projected prevalence of dementia in England and Wales, 2011-40. Thinner lines represent 95% uncertainty intervals

Fig 5 Projected prevalence of dementia in England and Wales, 2011-40, age standardised to the population of 2015. Thinner lines represent 95% uncertainty intervals

Fig 6 Sensitivity analysis for number of cases of dementia under alternative assumptions for calendar trend in incidence of dementia. Thinner lines represent 95% uncertainty intervals