The impact of diabetes mellitus and chronic obstructive pulmonary disease on mortality among people with dementia: a nationwide population-based cohort study

Abstract

Background: People with dementia have higher mortality compared to individuals without dementia. Dementia itself and comorbidity, but also impaired function and self-care, probably all contribute to the high mortality. Dementia is characterized by a high degree of comorbidity and demand for self-care, and so are Diabetes Mellitus (DM) and Chronic Obstructive Pulmonary Disease (COPD). All three diseases can severely impact functioning and quality of life. The aim of this study is to examine the excess mortality associated with DM and COPD in patients with dementia, compared with persons without these diseases, in Danish residents aged ≥ 65 years. Methods: The cohort included all individuals aged ≥ 65 years living in Denmark on January 1st, 2009, in total 874,426 individuals. All-cause mortality among persons with dementia, DM, and COPD was compared to persons free of these diseases. We estimated the incidence rate ratio (IRR), with confidence intervals (CI), for all-cause mortality associated with the three diseases separately, and in combination, using Cox regression models. Finally, to understand the consequences when diseases coexist, an interaction effect on mortality was calculated for all combinations of diseases as the IRR for the combination divided by the product of the IRR of the individual diseases. Results: The increase in all-cause mortality was IRR 2.86 (95% CI 2.83–2.89) for dementia, 1.45 (1.44–1.47) for DM, and 2.22 (2.20–2.24) for COPD. For the disease combinations mortality was IRR 3.93 (95% CI 3.83–4.04) for dementia and DM, 5.05 (95% CI 4.92–5.19) for dementia and COPD, and 3.34 (95% CI 3.26–3.41) for DM and COPD. Mortality for the combination of all three diagnoses was 5.66 (95% CI 5.36–5.98). The interaction effect on mortality was < 1, i.e. lower than expected from the total mortality related to the individual diseases, for all possible combinations of the three diseases, and lowest when dementia was involved in the combination. Conclusion: Dementia, DM, and COPD were independently, and in combination, associated with increased mortality. Contrastingly, coexistence seemed less deadly than the diseases on their own, possibly because they being discovered at an earlier stage, still, emphasizing the importance of focusing on shared health factors when treating patients with dementia.