Incidence of Intracerebral Hemorrhage in Patients With Mild Cognitive Impairment or Alzheimer’s Dementia in United States Veterans
Author(s)
Ying Wang, PhD1, Peter J Morin, MD, PhD2, Vanesa Arasa, MD, PhD2, Joel Reisman, BS3, Wen Hu, MS3, Dan Berlowitz, MD3, Raymond Zhang, MS4, Babak Haji, PhD4, Ran Gao, MS4, Amir Abbas Tahami Monfared, MD, PhD4, Quan Zhang, MA, MEd, MPhil, MS, PhD4, Weiming Xia, PhD2.
1Wentworth Institute of Technology, Boston, MA, USA, 2Boston University, Boston, MA, USA, 3University of Massachusetts, Lowell, MA, USA, 4Eisai, Inc, Nutley, NJ, USA.
1Wentworth Institute of Technology, Boston, MA, USA, 2Boston University, Boston, MA, USA, 3University of Massachusetts, Lowell, MA, USA, 4Eisai, Inc, Nutley, NJ, USA.
OBJECTIVES: This study evaluated the incidence of acute intracerebral hemorrhage (ICH) events in patients with mild cognitive impairment (MCI) or Alzheimer’s dementia (AD) in United States (US) Veterans.
METHODS: Veterans aged ≥50 years with MCI or AD were identified from combined Veterans Affairs Healthcare System (VAHS) and Medicare databases (2016-2023) and matched 1:1 to Veterans without MCI/AD by age, sex, and date of first MCI/AD ICD-10 coding. Acute ICH incidence was defined by principal inpatient ICD-10 coding for ICH (I61.0-I61.9, I60.8, I60.9) and analyzed with Poisson regression. ICH subtypes were defined as cerebral amyloid angiopathy (CAA), hypertensive (HTN) and nonspecific (NS) ICH according to clinician-postulated causal mechanisms.
RESULTS: Patients with MCI (n=508,912) or AD (n=238,563) were identified. For MCI vs AD, mean age was 75.5±10.1 vs 82.5±8.4 years, with 4.2% vs 2.4% female, 75.0% vs 75.1% White, 13.0% vs 9.7% Black/African American; ethnicity: 4.8% vs 5.3% Hispanic. The 5 most frequent comorbidities for patients with MCI, AD vs the comparison group were hypertension (81.8%, 86.0% vs 72.5%), prior dementia diagnosis (12.1%, 83.1% vs 2.7%), hypercholesterolemia (75.4%, 75.1% vs 66.1%), coronary artery disease (38.7%, 46.4% vs 31.6%), and vasculitis (38.7%, 45.6% vs 32.1%). Overall adjusted ICH incidence rates were 1.11, 1.26, vs 0.75 events/1000-patient years for MCI, AD vs comparison group. The incidence events/1000-patient years for CAA-, HTN-, and NS-ICH subtypes were 0.42, 0.06, and 0.59, respectively for MCI; 0.51, 0.07, 0.63 for AD; and 0.28, 0.05, and 0.39 for the comparison group. Increased risk of overall ICH events was associated with advanced age and prior health conditions including CAA, brain tumor, subarachnoid hemorrhage, cerebrovascular disease, liver cirrhosis, and hypertension.
CONCLUSIONS: This natural history study observed higher ICH events in AD relative to MCI or the matched comparison group in combined US VAHS and Medicare databases.
METHODS: Veterans aged ≥50 years with MCI or AD were identified from combined Veterans Affairs Healthcare System (VAHS) and Medicare databases (2016-2023) and matched 1:1 to Veterans without MCI/AD by age, sex, and date of first MCI/AD ICD-10 coding. Acute ICH incidence was defined by principal inpatient ICD-10 coding for ICH (I61.0-I61.9, I60.8, I60.9) and analyzed with Poisson regression. ICH subtypes were defined as cerebral amyloid angiopathy (CAA), hypertensive (HTN) and nonspecific (NS) ICH according to clinician-postulated causal mechanisms.
RESULTS: Patients with MCI (n=508,912) or AD (n=238,563) were identified. For MCI vs AD, mean age was 75.5±10.1 vs 82.5±8.4 years, with 4.2% vs 2.4% female, 75.0% vs 75.1% White, 13.0% vs 9.7% Black/African American; ethnicity: 4.8% vs 5.3% Hispanic. The 5 most frequent comorbidities for patients with MCI, AD vs the comparison group were hypertension (81.8%, 86.0% vs 72.5%), prior dementia diagnosis (12.1%, 83.1% vs 2.7%), hypercholesterolemia (75.4%, 75.1% vs 66.1%), coronary artery disease (38.7%, 46.4% vs 31.6%), and vasculitis (38.7%, 45.6% vs 32.1%). Overall adjusted ICH incidence rates were 1.11, 1.26, vs 0.75 events/1000-patient years for MCI, AD vs comparison group. The incidence events/1000-patient years for CAA-, HTN-, and NS-ICH subtypes were 0.42, 0.06, and 0.59, respectively for MCI; 0.51, 0.07, 0.63 for AD; and 0.28, 0.05, and 0.39 for the comparison group. Increased risk of overall ICH events was associated with advanced age and prior health conditions including CAA, brain tumor, subarachnoid hemorrhage, cerebrovascular disease, liver cirrhosis, and hypertension.
CONCLUSIONS: This natural history study observed higher ICH events in AD relative to MCI or the matched comparison group in combined US VAHS and Medicare databases.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
RWD104
Topic
Epidemiology & Public Health, Patient-Centered Research, Real World Data & Information Systems
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Geriatrics, Injury & Trauma, Neurological Disorders