A new study led by researchers at Duke University School of Medicine reveals that men diagnosed with dementia face a significantly higher risk of death than women, alongside greater use of many health care services, particularly hospital stays.
While women experience a higher incidence of dementia and often show faster cognitive and executive function decline, the mortality burden differs by sex. Some metabolic and cardiovascular risk factors appear to contribute more strongly to dementia in women, but the mechanisms behind these disparities remain complex.
At the population level in the U.S., women account for more dementia-related deaths—72.7 age-adjusted deaths per 100,000 person-years in 2017, compared with 56.4 per 100,000 for men. Whether this reflects higher mortality among women with dementia or simply greater incidence has been unclear.
The study, published in JAMA Neurology under the title “Sex Differences in Mortality and Health Care Utilization After Dementia Diagnosis,” analyzed Medicare data from 2014 to 2021, following 5,721,711 patients aged 65 and older, including 3,302,579 women and 2,419,132 men.
Researchers examined all-cause mortality and patterns of health care utilization, including hospitalizations, skilled nursing facility stays, neuroimaging, therapy services, and hospitalizations for neurodegenerative disease or behavioral disturbances.
Key findings included:
Adjusted mortality risk for men was 24% higher than for women, with crude one-year mortality rates of 27.2% for men versus 21.8% for women.
Men had higher adjusted hazards of all-cause hospitalization (8% higher) and hospitalization for neurodegenerative disease or behavioral disturbance (46% higher).
Men were slightly more likely to receive neuroimaging (4% higher) and hospice care (8% higher), but spent fewer days in hospice (8% fewer) and skilled nursing facilities (3% fewer).
Use of skilled nursing facilities and physical or occupational therapy was similar between sexes.
The researchers concluded that sex differences in overall dementia mortality are likely driven by higher incidence in women rather than elevated post-diagnosis mortality among female patients.
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