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. 2023 Jun 14;13(6):e068944.
doi: 10.1136/bmjopen-2022-068944.

Effects of Alzheimer's disease and related dementias on dental care usage and economic burden in older adults: a cross-sectional study

Minghui Li  1 , Isaac K Donkor  2 , Rongjie Shao  3 , Stephanie Hsieh  4 , Xiangxiang Jiang  5 , Liang Hong  6 , Z Kevin Lu  7
Affiliations

Effects of Alzheimer's disease and related dementias on dental care usage and economic burden in older adults: a cross-sectional study

Minghui Li et al. BMJ Open. .

Abstract

Aim: Distinct subtypes of Alzheimer's disease (AD) and related dementias (RD) might have different effects on dental care usage and economic burden. To determine the effects of AD and RD on specific types of dental care usage (preventive and treatment visits) and dental care costs from different payers (total and out-of-pocket costs).

Methods: A cross-sectional study was conducted using the Medicare Current Beneficiary Survey in 2016. This study identified 4268 community dwelling older adults with and without Alzheimer's disease and related dementias (ADRD) from a nationally representative sample of Medicare beneficiaries. Dental care usage and costs are based on self-reported data. Preventive dental events included preventive and diagnosis events. Treatment dental events included restorative, oral surgery and other events.

Results: This study identified 4268 (weighted N=30 423 885) older adults, including 94.48% without ADRD, 1.90% with AD and 3.63% with RD. Compared with older adults without ADRD, those with AD had similar dental care usage, but those with RD were 38% less likely to have treatment visit (OR: 0.62; 95% CI: 0.41 to 0.94) and had a 40% reduced number of total treatment visits (incidence rate ratio: 0.60; 95% CI: 0.37 to 0.98). RD was not associated with dental care costs, but AD was associated with higher total costs (β: 1.08; 95% CI: 0.14 to 2.01) and higher out-of-pocket costs (β: 1.25; 95% CI: 0.17 to 2.32).

Conclusions: Patients with ADRD were more likely to have adverse dental care outcomes. Specifically, RD was associated with lower treatment dental care usage and AD was associated with higher total and out-of-pocket dental care costs. Effective patient-centred strategies should be used to improve dental care outcomes in patients with distinct subtypes of ADRD.

Keywords: dementia; epidemiology; health economics.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
The impact of Alzheimer’s disease and related dementias on dental care visit. (A) The impact of Alzheimer’s disease on any dental care visit. (B) The impact of related dementias on any dental care visit. (C) The impact of Alzheimer’s disease on total dental care visits. (D) The impact of related dementias on total dental care visits. AD, Alzheimer’s disease; ADRD, Alzheimer’s disease and related dementias; IRR, incidence rate ratio; RD, related dementias. Covariates controlled: age, gender, race, education, marital status, income, residence, census region, comorbidity, caregiver and dental insurance.
Figure 2
Figure 2
The impact of Alzheimer’s disease and related dementias on dental care costs. (A) The impact of Alzheimer’s disease on total dental care costs. (B) The impact of related dementias on total dental care costs. (C) The impact of Alzheimer’s disease on out-of-pocket dental care costs. (D) The impact of related dementias on out-of-pocket dental care costs. AD, Alzheimer’s disease; ADRD, Alzheimer’s disease and related dementias; OOP, out-of-pocket; RD, related dementias. Covariates controlled: age, gender, race, education, marital status, income, residence, census region, comorbidity, caregiver and dental insurance.
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