Characterizing dementia among patients with spina bifida (SB).

BACKGROUND: Little is known about dementia among patients with spina bifida (SB). In this study we aim to characterize demographics and subtypes of dementia among individuals with SB compared to the general population. METHODS: We utilized the Department of Health Care Access and Information (HCAI) database to capture all inpatient encounters at California-licensed hospitals from 2005-2017. Two distinct analyses were performed: (I) comparing patients with dementia who had SB (n=528) to frequency-matched non-SB dementia controls (n=1,451), and (II) comparing SB patients with dementia (n=528) to frequency-matched SB patients without dementia (n=929). Patients with <50 years of age, missing linkage, missing birthdate, or non-California address were excluded. Demographic, socioeconomic, and healthcare-related variables were compared using Pearson's Chi-squared test and 2-tailed t-test with an alpha of 0.01. RESULTS: Our analytic cohort consisted of a SB with dementia group (n=528), a non-SB with dementia control group (n=1,451), and an SB without dementia comparison group (n=929). In the dementia cohort, the SB group had lower proportions of all-cause dementia (80% vs. 85%, P=0.01), Alzheimer's disease (23% vs. 34%, P<0.001), and Lewy Body dementia (3% vs. 6%, P=0.02) compared to the non-SB controls. Mean cumulative costs for all hospital encounters were significantly higher for SB patients with dementia ($677K) compared to non-SB patients with dementia ($387K, P<0.001) and SB patients without dementia ($374K, P<0.001). CONCLUSIONS: In this population-level study, we characterize dementia among patients with SB relative to the general population and its impact on healthcare utilization. Our study elucidates differences in the types of dementia SB patients experience as well as racial and socioeconomic differences relative to the general population. Further research will address the impact of dementia on healthcare outcomes among patients with SB.