Sex Differences in Healthcare Utilization in Persons Living with Dementia Between 2000 and 2017: A Population-Based Study in Quebec, Canada

Abstract

Objectives: Describe sex differences in healthcare utilization and mortality in persons with new dementia in Quebec, Canada. Methods: We conducted a repeated cohort study from 2000 to 2017 using health administrative databases. Community-dwelling persons aged 65+ with a new diagnosis of dementia were included. We measured 23 indicators of healthcare use across five care settings: ambulatory care, pharmacological care, acute hospital care, long-term care, and mortality. Clinically meaningful sex differences in age-standardized rates were determined graphically through expert consultations. Results: Women with dementia had higher rates of ambulatory care and pharmacological care, while men with dementia had higher acute hospital care, admission to long-term care, and mortality. There was no meaningful difference in visits to cognition specialists, antipsychotic prescriptions, and hospital death. Discussion: Men and women with dementia demonstrate differences in healthcare utilization and mortality. Addressing these differences will inform decision-makers, care providers and researchers and guide more equitable policy and interventions in dementia care.

Keywords: equity; health policy; healthcare utilization; persons with dementia; sex.

Figure 1.

Ambulatory care for community-dwelling adults 65 years or older with a new diagnosis of dementia in Quebec, Canada from 2000–2001 to 2016–2017 (N = 223 969). Note. This figure summarizes ambulatory care for men and women with dementia across 17 cohorts (x-axis) and age-standardized rates (y-axis). Rates for continuity of care are per 100-person-year, while those for visits to primary care physicians and visits to cognition specialists are per person-year. The blue line represents women, and the red line represents men. The panels are organized as follows: (a) rate of visits to primary care physicians in persons with dementia during the year following diagnosis; (b) continuity of care in the two years before the diagnosis; (c) continuity of care in the year after diagnosis; (d) rate of persons with a first record of diagnosis in primary care; (e) visits to cognition specialists in persons with dementia during the year following diagnosis. Note: Missing data for 2011–2012 for the rate of persons with a first record of diagnosis in primary care is due to the fact that the identification of prescribing doctors was not collected consistently in the pharmaceutical database during that year.

Figure 2.

Pharmacological care for community-dwelling adults 65 years or older with a new diagnosis of dementia in Quebec, Canada from 2000–2001 to 2016–2017 (N = 223 969). Note. This figure summarizes pharmacological care for men and women with dementia across 17 cohorts (x-axis) and age-standardized rates (y-axis). All rates are per 100-person-year. The blue line represents women, and the red line represents men. The panels are organized as follows: (a) rate of persons with dementia who are prescribed cholinesterase inhibitor during the year following diagnosis; (b) rate of persons with dementia who are prescribed memantine during the year following diagnosis; (c) rate of persons with dementia who are prescribed cholinesterase inhibitors or memantine by a primary care physician during the year following diagnosis; (d) rate of persons with dementia who are prescribed antidepressants during the year following diagnosis; (e) rate of persons with dementia who are prescribed benzodiazepine during the year following diagnosis; (f) rate of persons with dementia who are prescribed antipsychotics during the year following diagnosis. Note: Missing data for 2011–2012 for the rate of persons with dementia who are prescribed anti-dementia medication from primary care is due to the fact that the identification of prescribing doctors was not collected consistently in the pharmaceutical database during that year.

Figure 3.

Acute hospital care for community-dwelling adults 65 years or older with a new diagnosis of dementia in Quebec, Canada from 2000–2001 to 2016–2017 (N = 223 969). Note. This figure summarizes acute hospital care for men and women with dementia across 17 cohorts (x-axis) and age-standardized rates (y-axis). All rates are per 100-person-year, except for ED visits and days hospitalized, which are per person-year. The blue line represents women, and the red line represents men. The panels are organized as follows: A) rate of persons with dementia who have at least one emergency department (ED) visits during the year following diagnosis; B) rate of ED visits in persons with dementia during the year following diagnosis; C) rate of persons with dementia who have at least one hospitalization during the year following diagnosis; D) rate of days hospitalized in persons with dementia during the year following diagnosis.

Figure 4.

Potentially avoidable acute hospital care for community-dwelling adults 65 years or older with a new diagnosis of dementia in Quebec, Canada from 2000–2001 to 2016–2017 (N = 223 969). Note. This figure summarizes potentially avoidable acute hospital care for men and women with dementia across 17 cohorts (x-axis) and age-standardized rates (y-axis). All rates are per 100-person-year, except for days in alternate level of care, which are per person-year. The panels are organized as follows: (a) rate of persons with dementia who have at least one hospitalization with an ambulatory care sensitive condition (ACSC) for the aging/dementia population during the year following diagnosis; (b) rate of persons with dementia who have at least one hospitalization with an ACSC for the general population during the year following diagnosis; (c) rate of persons with dementia who were readmitted to the hospital within 30 days of discharge date during the year following diagnosis; (d) rate of persons with dementia who have at least one hospitalization with alternate level of care (ALC) during the year following diagnosis; (e) rate of days hospitalized with alternate level of care in persons with dementia during the year following diagnosis.

Figure 5.

Long-term care and mortality for community-dwelling adults 65 years or older with a new diagnosis of dementia in Quebec, Canada from 2000–2001 to 2016–2017 (N = 223 969). Note. This figure summarizes long-term care and mortality indicators for men and women with dementia across 17 cohorts (x-axis) and age-standardized rates (y-axis). All rates are per 100-person-year. The blue line represents women, and the red line represents men. The panels are organized the following way: (a) rate of persons with dementia who were admitted to long-term care in the year following the diagnosis, (b) rate of persons with dementia who died in the year following the diagnosis, and (c) rate persons with dementia who died at a hospital during the year following the diagnosis.