1. Causes of death reported on death certificates drastically underestimated dementia mortality burden by a factor of 2.7.
2. Non-Hispanic Black persons demonstrated significantly greater mortality burden than non-Hispanic White persons.
Evidence Rating Level: 2 (Good)
Dementia is a leading cause of death in the US and abroad, with Alzheimer’s disease accounting for approximately 80% of dementia cases. However, vital statistics are generally the method through which we determine mortality burden. Due to evidence suggesting that dementia is often underreported on death certificates, it is important to shift focus to population-based samples. This prospective cohort study of the Health and Retirement Study assessed noninstitutionalized individuals at baseline in 2000 and follow-up until 2009. A total of 7,342 adults (60.3% female) between the ages of 70 and 99 years were interviewed and included in the study. Three ten-year age groups were established to determine the representation of the sample: 70-79 (64.0%), 80-89 (31.0%), 90-99 (5.0%). The total percentage of deaths attributable to dementia was 13.6% (95% CI 12.2 to 15.0). The mortality burden of dementia was significantly higher among adults with less than a high school education (16.2%, 95% CI 13.2 to 19.0) compared to individuals with a college education (9.8%, 95% CI 7.0 to 12.5). This burden was also significantly greater among non-Hispanic Black individuals (24.7%, 95% CI 17.3 to 31.4) compared to non-Hispanic White person (12.2%, 95% CI 10.7 to 13.6). Causes of deaths reported on death certificates (5.0%, 95% CI 4.3 to 5.8) drastically underestimated dementia’s contribution to mortality in the US by a factor of 2.7. When incorporating deaths due to cognitive impairment without dementia, underestimation of dementia mortality burden was even greater. Overall, this study suggests that the standard mortality statistics utilized to determine dementia mortality burden may be significantly underestimated, calling for a need to incorporate population-based studies and interventions.
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