Is the Rise in Reported Dementia Mortality Real? Analysis of Multiple-Cause-of-Death Data for Australia and the United States

Abstract

Official statistics in Australia and the United States show large recent increases in dementia mortality rates. In this study, we assessed whether these trends are biased by an increasing tendency of medical certifiers (predominantly physicians) to report on the death certificate that dementia was a direct cause of death. Regression models of multiple-cause-of-death data in Australia (2006-2016) and the United States (2006-2017) were constructed to adjust dementia mortality rates for changes in death certification practices. Compared with official statistics, the recent increase in adjusted age-standardized dementia death rates was less than half as large in Australia and about two-thirds as large in the United States. Further adjustment for changes in reporting of dementia anywhere on the death certificate implied even lower increases in dementia mortality. Declines in reporting of cardiovascular diseases as comorbid conditions also contributed to rises in dementia mortality rates. The increasing likelihood of dementia's being reported as directly leading to death largely explains recent increases in dementia mortality rates in both countries. However, studies have found that reported dementia on death certificates remains low compared with clinical evaluations of its prevalence. Improved guidance and training for certifiers in reporting of dementia on death certificates will help standardize mortality statistics within and between countries.

Keywords: Australia; United States; cardiovascular disease; causes of death; dementia; mortality; vital statistics.

Figure 1

Age-standardized death rates (ASDRs) (number of deaths per 100,000 persons) for deaths with dementia reported as an underlying cause of death (UCOD) and dementia reported as one of multiple causes of death (MCOD) among individuals aged ≥50 years, by sex, Australia (2006–2016) (A) and United States (2006–2017) (B). Death rates were age-standardized to the 2006 Australian population of both sexes.

Figure 2

Age-standardized death rates (ASDRs) (number of deaths per 100,000 persons) for deaths with dementia reported as an underlying cause of death and cardiovascular disease (CVD) reported as an underlying cause of death (percentage of dementia multiple-cause-of-death (MCOD) cases) among persons aged ≥50 years, by sex, Australia (2006–2016) (A) and United States (2006–2017) (B).

Figure 3

Age-standardized death rates (ASDRs) (number of deaths per 100,000 persons) for deaths with dementia reported as an underlying cause of death among persons aged ≥50 years, observed, adjusted to the most recent year (2016 in Australia, 2017 in the United States), and adjusted to the most recent year while assuming constant dementia multiple-cause-of-death (MCOD) ASDRs, by sex, Australia (2006–2016) (A) and United States (2006–2017) (B).