Burden of disease
Burden of disease refers to the quantified impact of a disease or injury on an individual or population. Dementia was the fourth leading cause of disease and injury burden among the Australian population in 2015, and was responsible for 3.8% of the total burden of disease and injury, equal to 179,804 disability-adjusted life years (DALY). The burden from dementia accounted for a greater proportion of the total burden for females than males, accounting for 5.0% of total DALY for females and 2.7% for males. This is influenced by the fact that women live longer than men and therefore are more likely to develop dementia. Females comprised 52% of dementia hospitalisations (Figure 3) and 58% of people dispensed anti-dementia medicines in 2017–18.
As expected, the dementia burden was also higher among people aged 65 and over, for whom it was the second leading cause of total burden of disease and injury (7.7% of total DALY) (AIHW 2019c).
See Burden of disease.
Expenditure
The Australian Disease Expenditure Study estimated that about $428 million in health expenditure (excluding aged care expenditure) was attributable to dementia in Australia in 2015–16, with $5.5 million more spent on females than males. More than $324 million was spent on hospital-related services for people with dementia—which includes both public and private sectors and admitted and non-admitted care. Public hospital admitted patients were the largest contributor to hospital expenditure, accounting for $212 million. Almost $90 million was spent on public hospital outpatient services, around $17 million on private hospital services, and $5.1 million was spent on public hospital emergency department services. Public hospital outpatient expenditure was higher for females than for males (about $49 million for females compared with about $41 million for males). However, public hospital admitted patient expenditure was higher for males—$112 million was spent on the care of males compared with $100 million on females (AIHW 2019d).
In the same year (2015–16), more than $40 million was spent on medicines for people with dementia. About half of this was for 4 specific medicines that are prescribed to treat Alzheimer’s disease—Donepezil, Galantamine, Rivastigmine and Memantine (see the blue box below for more information on these medicines) (AIHW 2019b). Services provided by specialists accounted for more than $16 million while general practitioner services accounted for almost $23 million, and $3.1 million was spent on allied health and other services. About $13 million was spent on general practitioner services for females compared with $9.6 million for males (AIHW 2019d).
See Health expenditure.
Hospitalisations
In 2017–18, dementia was recorded as the principal and/or additional diagnosis in 93,800 hospitalisations (Figure 3). Although more than half of these hospitalisations involved females (52%), after accounting for differences in age and population size, males were 1.3 times as likely to be hospitalised with dementia as females. The majority of people hospitalised with a principal and/or additional diagnosis of dementia were aged 85–94 (43%), while 3.3% were under 65 and 4.6% were over 95.
See Hospital care.
Trends in hospitalisations
The number of hospitalisations where dementia was recorded as the principal and/or additional diagnosis fluctuated between 2008–09 and 2017–18, from about 86,700 to 93,800 (Figure 3). Overall, the rate of hospitalisations involving dementia decreased by 17% in this period—from 357 to 296 hospitalisations per 100,000 population.
It is not clear why there has been a decrease in the rate of dementia hospitalisations, however some of the decrease may be due to changes to the way dementia is coded in hospitals data. For example, in 2015, 29 supplementary codes for chronic conditions (including dementia) and a new Australian Coding Standard were implemented in the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification, 9th edition, and the Australian Coding Standards, which are used to record diagnoses in hospitals data (see AIHW 2019a for further information). Further research is required to determine the influence, if any, of the supplementary codes on the coding of hospitalisations for dementia as this section includes dementia hospitalisations as the principal and/or additional diagnosis only.
Hospitalisations for individual types of dementia (principal and/or additional diagnosis) also changed over time. While the number of hospitalisations involving unspecified dementia decreased by 42%, there was an increase in the number of hospitalisations involving vascular dementia (79%), Alzheimer’s disease (39%) and delirium superimposed on dementia (310%).
Similar to the trends in the number of hospitalisations by dementia type, there was a decrease in the age-adjusted rate of hospitalisations involving unspecified dementia (56%), and an increase in the age-adjusted rate for hospitalisations involving vascular dementia (39%), Alzheimer’s disease (6%) and delirium superimposed on dementia (211%).
The large increase in the number and rate of hospitalisations involving delirium superimposed on dementia may be a result of a marked increase in awareness and education for delirium during this decade (Department of Health and Ageing 2011; Department of Health & Human Services 2011).