Sex Differences in Dementia: Survival, Institutionalization, and Costs Based on Dutch Claims Data.

OBJECTIVES

This study investigates sex differences in institutionalization, mortality, and health care costs among individuals with dementia.

DESIGN

Retrospective cohort study using nationwide Dutch health insurance claims data with 6 years of follow-up.

SETTING AND

PARTICIPANTS

15,214 people diagnosed with dementia in 2018 from all Dutch hospitals.

METHODS

We used a multistate model to examine transitions between community, institutional care, and death. We estimated differences in annual health care and long-term care costs between men and women using bootstrapped multilevel analyses, adjusting for age, previous health care use, a diagnosing specialist, institutionalization, and time × sex interactions.

RESULTS

The cohort included 6749 men (78.2 ± 7.5 years) and 8465 women (55.6%; 79.5 ± 7.5 years). Women had a higher risk of institutionalization than men (hazard ratio [HR], 1.21; 95% CI, 1.16-1.26) and lower mortality once institutionalized (HR, 0.61; 95% CI, 0.58-0.64), resulting in longer stays (median, 2.44 vs 1.47 years). Women also had lower overall mortality (HR, 0.72; 95% CI, 0.70-0.75). On average, women had lower yearly health care costs (-€1297; 95% CI, -€1597 to -€1086) but higher long-term care costs (€11,247; 95% CI, €10,462-€11,852) than men across care settings. While adjustment for age and institutionalization reduced the differences, they remained significant. In addition, women's long-term care costs increased more over time (€1129 per year; 95% CI, €899-€1308), whereas their health care costs decreased more (-€246 per year; 95% CI, -€394 to -€121).

CONCLUSIONS AND IMPLICATIONS: Women lived longer with dementia than men and used more formal long-term care, both at home and in institutional settings. These findings highlight the need for care systems to account for sex-specific differences in care trajectories when planning and financing long-term dementia care.