Utilization patterns and clinical factors associated with hospitalization in early-stage dementia with Lewy bodies

Objectives
Characterize patterns of hospitalization and emergency department (ED) visits in early-stage dementia with Lewy bodies (DLB).

Methods
We analyzed electronic health records and claims data from a U.S. healthcare system up to 3 years before/after initial diagnosis of DLB (n = 175), Alzheimer's disease (AD, n = 2478), or vascular dementia (VD, n = 513). Controls were randomly matched 3:1 with the DLB group on sex/age (n = 525). Generalized linear models were used to compare rates and types of utilization between diagnosis group with adjustment for patient characteristics.

Results
Patients with DLB had significantly greater rates of hospitalization and ED visits compared to patients with AD (Incidence Rate Ratio (IRR): 1.46, 95% CI 1.24, 1.73, IRR: 1.46, 95% CI 1.29, 1.77, respectively) and controls (IRR: 1.77, 95% CI 1.46, 2.14, IRR: 2.21, 95% CI 1.82, 2.69, respectively) and ED visits compared to those with VD (IRR: 1.24, 95% CI 1.03, 1.50). Patients with DLB were over 50% more likely to have a hospitalization associated with falls compared to those with AD and VD (OR: 1.75, 95% CI 1.16, 2.62 OR: 1.56, 95% CI: 1.01, 2.48, respectively). Compared to patients with AD, DLB patients were found to have 2.9-time higher likelihood of experiencing at least one hospitalization (Odds Ratio: 2.89. 95% CI: 1.17, 6.45).

Conclusions
Patients with DLB were substantially more likely to utilize ED services than patients with AD, VD, or controls, and more likely to experience hospitalizations compared to AD and control groups. Fall prevention and psychiatric treatment may be particularly important in reducing hospitalizations in early-stage DLB.