Effects of Socioeconomic Status on Alzheimer Disease Mortality in Taiwan

• Published in: The American journal of geriatric psychiatry 2020-02, Vol.28 (2), p.205-216
• Main Authors: Chen, Chien-Liang, Liang, Chih-Kuang, Yin, Chun-Hao, Lin, Yu-Te, Lee, Ching-Chih, Chen, Nai-Ching
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Alzheimer disease; Alzheimer Disease - mortality; Alzheimer Disease - therapy; Alzheimer's disease; dementia; Female; Health Status Disparities; Humans; Male; Mortality; National Health Programs; Poverty Areas; Proportional Hazards Models; Residence Characteristics; Retrospective Studies; Risk Factors; Social Class; Socioeconomic factors; Socioeconomic status; Survival Rate; Taiwan - epidemiology
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1016/j.jagp.2019.06.010

•The effects of individual and neighborhood socioeconomic status on Alzheimer disease mortality in Taiwan.•Patients with Alzheimer's disease and a low individual socioeconomic status exhibited the worst survival rate, especially those in disadvantage areas. In contrast, after adjustment for characteristics, the mortality risk of the patients with a high individual socioeconomic status in disadvantaged areas remained similar to that of patients with a high individual socioeconomic status in advantaged areas (hazard ratio: 0.93; 95% confidence interval: 0.64–1.35).•Findings from this study demonstrate that the mortality of low individual socioeconomic status could be impacted by neighborhood socioeconomic status. Public health providers should be mindful that providing welfare care of an advantaged neighborhood socioeconomic status is potentially helpful in patients with Alzheimer's disease and a low socioeconomic status. The combined effects of individual and neighborhood socioeconomic status (SES) on survival rates of patients with Alzheimer's disease (AD) remain unclear. Retrospective cohort study. National Health Insurance Bureau of Taiwan data (2003–2012). Patients with AD. The authors aimed to analyze the effects of neighborhood and individual SES on the 5-year survival rates of patients with AD. The author defined individual and neighborhood SES based on income-related insurance payment amounts and residence in advantaged versus disadvantaged areas and compared survival rates using the Cox proportional hazards model after adjusting for risk factors. A total of 1,754 patients with AD were identified. Each patient was followed for 5 years or censored. The 5-year overall survival rates were worst for those with a low individual SES in a disadvantaged area. After adjustment for sex, age, and comorbidities, patients with a low individual SES living in disadvantaged areas had the worse survival rate than those with a high SES (hazard ratio: 2.19; 95% confidence interval [CI]: 1.53–3.13). In contrast, after the adjustment for characteristics, patients with a high individual SES in disadvantaged areas had a similar mortality rate to those with a high individual SES in advantaged areas (hazard ratio: 0.93; 95% CI: 0.64–1.35). Despite universal health coverage, patients with AD and a low individual SES in disadvantaged areas exhibited the worst survival rate. The socioeconomic survival gradient among patients with AD in Taiwan may result from differences in maj