Excess dementia-related deaths declined in second year of COVID-19 pandemic

Dementia-related deaths rose substantially during the first year of the COVID-19 pandemic but fell in the second year. The decline during year two appears to be largely due to decreased cases of COVID in nursing home and long-term care settings, according to an NIA-funded study published in JAMA Neurology.

Researchers from the University of California, San Francisco and other institutions analyzed death certificates of more than 2 million adults 65 years old and older that mention Alzheimer’s disease or a related dementia from the National Center for Health Statistics Mortality Surveillance System. Next, they analyzed U.S. Census Bureau Population Estimates Program data from January 2014 to February 2020 to estimate the number of dementia-related deaths that would have been expected had the pandemic not happened.

The difference between expected and actual deaths during the first year (March 2020 to February 2021) and second year (March 2021 to February 2022) of the pandemic were considered excess deaths. To understand how the availability of vaccines influenced excess mortality, the researchers analyzed COVID-19 vaccination data from the U.S. Centers for Disease Control and Prevention COVID Data Tracker. In addition to examining the overall population, the researchers analyzed data on age, race, ethnicity, and place of death.

In the first pandemic year, there were nearly 95,000 excess dementia-related deaths. This number declined by 77% in the second year to approximately 22,000 excess deaths. Significant year two declines occurred for all demographic groups and was associated with vaccine rollout. In states with faster vaccine rollout and greater coverage, there were larger reductions in excess dementia-related deaths.

Though all groups experienced declines in year two, not everyone experienced the same level of decline. Nursing home and long-term care residents experienced the largest decrease in year two excess deaths, while those living at home only experienced modest declines. This may suggest that older adults with Alzheimer’s or a related dementia living in the community, rather than in nursing and long-term care facilities, may not have equally benefitted from COVID-19 prevention efforts. Racial and ethnic disparities in excess deaths were also apparent throughout the pandemic.

Examining the number of additional deaths related to dementia during the pandemic and observing any fluctuations can offer valuable insights into the effectiveness of COVID-19 preventions and treatments developed in the initial year of the pandemic, particularly in safeguarding older adults. A limitation of the study was the use of death certificate data from 2022 that had not yet been finalized. Next steps may involve investigating the reasons behind the persistently high number of excess deaths among older adults with dementia who lived at home throughout the pandemic. Additionally, these findings highlight the need to identify measures that can help reduce disparities in excess deaths among various groups.

This research was supported in part by NIA grants K00AG068431 and F31AG079651.

These activities relate to NIH’s Alzheimer’s and Related Dementias Research Implementation Milestone 1.U, “Explore interaction of social, structural, and systemic inequalities, comorbidities and social and medical interventions with risk and neurocognitive sequelae of COVID-19.”

Reference: Chen R, et al. Excess mortality with Alzheimer disease and related dementias as an underlying or contributing cause during the COVID-19 pandemic in the US. JAMA Neurology. 2023. Epub July 17. doi: 10.1001/jamaneurol.2023.2226.