Suchergebnisse

ABSTRACTObjectiveEfforts to enable persons with dementia to remain at home longer, and to reduce use of costly acute care resources, are at the forefront of policy agendas internationally. Foundational to planning appropriate health system supports is the ongoing, comparable and accurate estimation of the prevalence and incidence of dementia across regions, as well as associated patterns of health services use and cost. Our objective was to explore emerging approaches to using population data in dementia research and demonstrate the policy contribution of the resulting new knowledge.
ApproachUsing population-based health administrative data and an algorithm that was validated using electronic medical records, we developed a series of repeated, cross-sectional cohort studies to examine trends in dementia prevalence, incidence and publicly-funded health service use and costs between 2004/05 and 2013/14 among adults aged 65 years and older in Ontario, Canada. Trends in yearly rates of health service use were assessed using regression models for serially correlated data and compared to a 1:1 matched control group based on age, sex, geographic region and comorbidity level.
ResultsOver time, age- and sex-adjusted prevalence of dementia increased by 18.2% (from 63.0 to 74.5 per 1,000 persons; p-value < 0.001) and age- and sex-adjusted incidence decreased slightly (from 18.2 to 17.0 per 1,000 persons; p-value = 0.05). Community-dwelling persons with dementia were more likely than matched controls to be placed in long-term care (11.8% vs. 1.5% in 2013; p<0.001) and use home care (45.8% vs 23.2%; p<0.001) but equally likely to visit family physicians (93.9% vs. 94.8% in 2013) and specialists (87.1% vs. 89.4%). Median costs associated with one year of health system use were $19,468 (interquartile range (IQR) $4,490 to $47,726) for prevalent cases in 2012/13 and $16,549 (IQR $5,070 to $47,899) for incident cases. Long-term care and hospital care accounted for the largest portion of total costs in both groups.
ConclusionThe prevalence of dementia has increased in Ontario, Canada over time and, given slightly declining incidence rates, is likely attributable to improved survival. Surveillance of dementia with health administrative data is a cost-effective tool for describing and monitoring trends in incidence and prevalence over time, and for supporting health system capacity planning. This comparative information is critical to understanding the impact of policy decisions designed to address dementia-related health care needs at a population level.

We study the long-term impact of climate change on economic activity across countries, using a stochastic growth model where labour productivity is affected by country-specific climate variables--defined as deviations of temperature and precipitation from their historical norms. Using a panel data set of 174 countries over the years 1960 to 2014, we find that per-capita real output growth is adversely affected by persistent changes in the temperature above or below its historical norm, but we do not obtain any statistically significant effects for changes in precipitation. Our counterfactual analysis suggests that a persistent increase in average global temperature by 0.04°C per year, in the absence of mitigation policies, reduces world real GDP per capita by 7.22 percent by 2100. On the other hand, abiding by the Paris Agreement, thereby limiting the temperature increase to 0.01°C per annum, reduces the loss substantially to 1.07 percent. These effects vary significantly across countries. We also provide supplementary evidence using data on a sample of 48 U.S. states between 1963 and 2016, and show that climate change has a long-lasting adverse impact on real output in various states and economic sectors, and on labor productivity and employment