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. 2021 Aug;17(8):1297-1306.
doi: 10.1002/alz.12296. Epub 2021 Feb 9.

COVID-19 and dementia: Analyses of risk, disparity, and outcomes from electronic health records in the US

QuanQiu Wang  1 , Pamela B Davis  2 , Mark E Gurney  3 , Rong Xu  1
Affiliations

COVID-19 and dementia: Analyses of risk, disparity, and outcomes from electronic health records in the US

QuanQiu Wang et al. Alzheimers Dement. 2021 Aug.

Abstract

Introduction: At present, there is limited data on the risks, disparity, and outcomes for COVID-19 in patients with dementia in the United States.

Methods: This is a retrospective case-control analysis of patient electronic health records (EHRs) of 61.9 million adult and senior patients (age ≥ 18 years) in the United States up to August 21, 2020.

Results: Patients with dementia were at increased risk for COVID-19 compared to patients without dementia (adjusted odds ratio [AOR]: 2.00 [95% confidence interval (CI), 1.94-2.06], P < .001), with the strongest effect for vascular dementia (AOR: 3.17 [95% CI, 2.97-3.37], P < .001), followed by presenile dementia (AOR: 2.62 [95% CI, 2.28-3.00], P < .001), Alzheimer's disease (AOR: 1.86 [95% CI, 1.77-1.96], P < .001), senile dementia (AOR: 1.99 [95% CI, 1.86-2.13], P < .001) and post-traumatic dementia (AOR: 1.67 [95% CI, 1.51-1.86] P < .001). Blacks with dementia had higher risk of COVID-19 than Whites (AOR: 2.86 [95% CI, 2.67-3.06], P < .001). The 6-month mortality and hospitalization risks in patients with dementia and COVID-19 were 20.99% and 59.26%, respectively.

Discussion: These findings highlight the need to protect patients with dementia as part of the strategy to control the COVID-19 pandemic.

Keywords: Alzheimer's disease; COVID-19; dementia; patient electronic health records.

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Conflict of interest statement

QuanQiu Wang, Pamela B. Davis, Mark E. Gurney and Rong Xu have no financial interests to disclose.

Figures

FIGURE 1
FIGURE 1
Odds of COVID‐19 in patients with dementia compared to patients without dementia, after adjusting for age, sex, race, and COVID‐19 risk factors including asthma, cardiovascular diseases, cancer, type 2 diabetes, obesity, chronic kidney diseases, chronic obstructive pulmonary disease, substance use disorders, transplant procedures (bone marrow, solid organ), and nursing home stay status. AOR, adjusted odds ratio; CI, confidence interval
FIGURE 2
FIGURE 2
Odds of COVID‐19 in patients with dementia compared to patients without dementia, after adjusting for demographics (age, sex, race). AOR, adjusted odds ratio; CI, confidence interval
FIGURE 3
FIGURE 3
Effects of demographics on odds of COVID‐19 among patients with dementia, after adjusting for age, sex, race, and COVID‐19 risk factors including asthma, cardiovascular diseases, cancer, type 2 diabetes, obesity, chronic kidney diseases, chronic obstructive pulmonary disease, substance use disorders, transplant procedures (bone marrow, solid organ), and nursing home stay status. AOR, adjusted odds ratio; CI, confidence interval
FIGURE 4
FIGURE 4
Six‐month hospitalization and mortality risks among three adult (age > 18) population: patients with both dementia (or Alzheimer's disease [AD]) and COVID‐19, patients with COVID‐19 but no dementia, and patients with dementia (or AD) but no COVID‐19. ***: P < .001; **: P < .01; ns, not significant
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