Date Published: March 7, 2017
Publisher: Public Library of Science
Author(s): Emma F. van Bussel, Edo Richard, Derk L. Arts, Astrid C. J. Nooyens, Preciosa M. Coloma, Margot W. M. de Waal, Marjan van den Akker, Marion C. J. Biermans, Markus M. J. Nielen, Kees van Boven, Hugo Smeets, Fiona E. Matthews, Carol Brayne, Wim B. Busschers, Willem A. van Gool, Eric P. Moll van Charante, Bruce L Miller
Abstract: BackgroundRecent reports have suggested declining age-specific incidence rates of dementia in high-income countries over time. Improved education and cardiovascular health in early age have been suggested to be bringing about this effect. The aim of this study was to estimate the age-specific dementia incidence trend in primary care records from a large population in the Netherlands.Methods and findingsA dynamic cohort representative of the Dutch population was composed using primary care records from general practice registration networks (GPRNs) across the country. Data regarding dementia incidence were obtained using general-practitioner-recorded diagnosis of dementia within the electronic health records. Age-specific dementia incidence rates were calculated for all persons aged 60 y and over; negative binomial regression analysis was used to estimate the time trend. Nine out of eleven GPRNs provided data on more than 800,000 older people for the years 1992 to 2014, corresponding to over 4 million person-years and 23,186 incident dementia cases. The annual growth in dementia incidence rate was estimated to be 2.1% (95% CI 0.5% to 3.8%), and incidence rates were 1.08 (95% CI 1.04 to 1.13) times higher for women compared to men. Despite their relatively low numbers of person-years, the highest age groups contributed most to the increasing trend. There was no significant overall change in incidence rates since the start of a national dementia program in 2003 (−0.025; 95% CI −0.062 to 0.011). Increased awareness of dementia by patients and doctors in more recent years may have influenced dementia diagnosis by general practitioners in electronic health records, and needs to be taken into account when interpreting the data.ConclusionsWithin the clinical records of a large, representative sample of the Dutch population, we found no evidence for a declining incidence trend of dementia in the Netherlands. This could indicate true stability in incidence rates, or a balance between increased detection and a true reduction. Irrespective of the exact rates and mechanisms underlying these findings, they illustrate that the burden of work for physicians and nurses in general practice associated with newly diagnosed dementia has not been subject to substantial change in the past two decades. Hence, with the ageing of Western societies, we still need to anticipate a dramatic absolute increase in dementia occurrence over the years to come.
Partial Text: Since dementia care places a heavy social and economic burden on society, future projections of dementia prevalence rates are important for health care planning. In view of a growing and ageing population, an increasing number of older people are at risk for dementia . It is estimated that the prevalence of dementia will nearly double every 20 y, to 132 million in 2050 worldwide . Recently, cohort studies from Europe and the United States have suggested a declining trend in age-specific dementia incidence rates over the last 30 y [3–12]. This putative decline is mostly attributed to better education and vascular risk factor treatment [5,9], and fuels hope that the absolute increase in dementia prevalence might be more moderate than previously anticipated.
All eleven Dutch GPRNs were willing to participate. However, one GPRN (in Amsterdam) was able to deliver coherent incidence data only for the years 2010 to 2013 and was excluded from participation. Another GPRN (in Groningen) was excluded because its data were already part of another database within this study (NIVEL-PCD). The other nine databases, representing over 806,051 older persons, were eligible and were used for this trend study (Table 1).
This study evaluated whether there was a declining trend in dementia incidence rate in the Netherlands, using a real-world sample of routinely collected data from primary care networks comprising over 800,000 people aged 60 y and over. Pooled data from nine GPRNs showed a dementia incidence rate ratio of 1.021 (95% CI 1.005 to 1.038) per year between 1992 and 2014, with higher incidence rates among women than among men and no significant change since the start of a national dementia program in 2003.