Inequalities in the burden of disease due to dementia, including Alzheimer disease, in British Columbia, Canada, from 2001 to 2022

Introduction Disability-adjusted life-years (DALYs) integrate mortality and prevalence (or incidence) data. DALYs can be used as a surveillance measure to assess dementia burden and inequalities. Methods We utilized dementia case and mortality counts from linked administrative data to estimate incidence, prevalence, cause-specific mortality and DALYs in people aged 65 years and older, from 2001 to 2022, in British Columbia, Canada. Dementiaspecific mortality rates adjusted for changes in death certification practices over time were estimated using logistic regression that incorporated multiple cause-of-death data from vital statistics records. All measures were stratified by sex; DALYs were also stratified by age and area-based socioeconomic status (SES) quintiles. Average annual percent change (AAPC) in rates was estimated using joinpoint regression. Results Age-standardized dementia incidence and prevalence have declined since 2013, while mortality has increased by, on average, 1.6% per year since 2001 (95% CI: 1.4% to 1.8%). Age-standardized DALYs have increased by, on average, 1.4% per year (95% CI: 1.3% to 1.4%). DALY rates are highest in females aged 90 years and older but are increasing more rapidly in males. DALYs have declined for those in the least deprived SES quintile (AAPC: −0.6%; 95% CI: −1.0% to −0.3%) and conversely, have increased — with recent rates the highest — in the most deprived quintile (AAPC: 2.9%; 95% CI: 2.5% to 3.2%). Conclusion The socioeconomic gap in dementia disease burden has widened over time in British Columbia. DALYs are highest in females aged 90 years and older, but the overall gap between males and females has declined.