Population incidence and associated mortality of urinary tract infection in people living with dementia
Helen Lai, Magdalena Kolanko, Lucia M. Li, Megan E Parkinson, Niall Bourke, Neil S N Graham, Michael David, Emma‐Jane Mallas, Bowen Su, Sarah Daniels, Danielle Wilson, Mara Golemme, Claire Norman, Kirsten Jensen, Raphaella Jackson, Martin Tran, Paul S Freemont, David Wingfield, Tim Wilkinson, Edward W. Gregg, Ioanna Tzoulaki, David J Sharp, Eyal Soreq
Abstract
OBJECTIVES: Urinary tract infections (UTIs) frequently cause hospitalisation and death in people living with dementia (PLWD). We examine UTI incidence and associated mortality among PLWD relative to matched controls and people with diabetes and investigate whether delayed or withheld treatment further impacts mortality. METHODS: Data were extracted for n = 2,449,814 people aged ≥ 50 in Wales from 2000-2021, with groups matched by age, sex, and multimorbidity. Poisson regression was used to estimate incidences of UTI and mortality. Cox regression was used to study the effects of treatment timing. RESULTS: UTIs in dementia (HR=2.18, 95 %CI [1.88-2.53], p < .0) and diabetes (1.21[1.01-1.45], p = .035) were associated with high mortality, with the highest risk in individuals with diabetes and dementia (both) (2.83[2.40-3.34], p < .0) compared to matched individuals with neither dementia nor diabetes. 5.4 % of untreated PLWD died within 60 days of GP diagnosis-increasing to 5.9 % in PLWD with diabetes. CONCLUSIONS: Incidences of UTI and associated mortality are high in PLWD, especially in those with diabetes and dementia. Delayed treatment for UTI is further associated with high mortality.