Alzheimer incidence and prevalence with and without asthma: A Medicare cohort study - 15/05/24

Doi : 10.1016/j.jaci.2024.04.008

Christie M. Bartels, MD, MS ^a,^b,^⁎^{^{∗
Co-first authors.}} , Yi Chen, MS ^c,^{^{∗
Co-first authors.}}, W. Ryan Powell, PhD, MA ^b,^d, Melissa A. Rosenkranz, PhD ^e,^f, Barbara B. Bendlin, PhD ^b,^d, Joseph Kramer, MA ^b, William W. Busse, MD ^g,^{^{‡
Co-senior authors.}}, Amy Kind, MD, PhD ^b,^d,^{^{‡
Co-senior authors.}}
^a Rheumatology Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
^b Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, Wis
^c Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
^d Geriatrics Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
^e Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wis
^f Center for Healthy Minds, University of Wisconsin—Madison, University of Wisconsin School of Medicine and Public Health, Madison, Wis
^g Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis

^∗Corresponding author: Christie M. Bartels, MD, MS, Rheumatology Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, MFCB #4132, 1685 Highland Ave, Madison, WI 53705.Rheumatology DivisionDepartment of MedicineUniversity of Wisconsin School of Medicine and Public HealthMFCB #41321685 Highland AveMadisonWI53705

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Abstract

Background

International data suggest that asthma, like other inflammatory diseases, might increase Alzheimer disease (AD) risk.

Objective

We sought to explore risk pathways and future mitigation strategies by comparing diagnostic claims-based AD incidence and prevalence among US patients with asthma with those without asthma.

Methods

This cohort study included a national Medicare 20% random sample (2013-2015). Adult patients with asthma with more than 12 months continuous Medicare were compared with subjects without asthma overall and as matched. Asthma was defined by 1 inpatient or 2 outpatient codes for asthma. The main outcomes were 2-year incident or prevalent AD defined by International Classification of Diseases, Ninth Revision code 331.0 or Tenth Revision code G30.0, G30.1, G30.8, or G30.9.

Results

Among 5,460,732 total beneficiaries, 678,730 patients were identified with baseline asthma and more often identified as Black or Hispanic, were Medicaid eligible, or resided in a highly disadvantaged neighborhood than those without asthma. Two-year incidence of AD was 1.4% with asthma versus 1.1% without asthma; prevalence was 7.8% versus 5.4% (both P ≤ .001). Per 100,000 patients over 2 years, 303 more incident AD diagnoses occurred in those with asthma, with 2,425 more prevalent cases (P < .001). Multivariable models showed that asthma had greater odds of 2-year AD incidence (adjusted odds ratio, 1.33 [95% CI, 1.29-1.36]; matched 1.2 [95% CI, 1.17-1.24]) and prevalence (adjusted odds ratio, 1.48 [95% CI, 1.47-1.50]; matched 1.25 [95% CI, 1.22-1.27]).

Conclusions

Asthma was associated with 20% to 33% increased 2-year incidence and 25% to 48% increased prevalence of claims-based AD in this nationally representative US sample. Future research should investigate risk pathways of underlying comorbidities and social determinants as well as whether there are potential asthma treatments that may preserve brain health.

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Key words : Asthma, Alzheimer, systemic inflammation, cohort study, claims-based data, observational study

Abbreviations used : AD, ADI, ICD-9-CM, OR, RA