Sex Differences in Dementia: Survival, Institutionalization, and Costs Based on Dutch Claims Data

OBJECTIVES: This study investigates sex differences in institutionalization, mortality, and health care costs among individuals with dementia. DESIGN: Retrospective cohort study using nationwide Dutch health insurance claims data with 6 years of follow-up. SETTING AND PARTICIPANTS: 15,214 people diagnosed with dementia in 2018 from all Dutch hospitals. METHODS: We used a multistate model to examine transitions between community, institutional care, and death. We estimated differences in annual health care and long-term care costs between men and women using bootstrapped multilevel analyses, adjusting for age, previous health care use, a diagnosing specialist, institutionalization, and time × sex interactions. RESULTS: The cohort included 6749 men (78.2 ± 7.5 years) and 8465 women (55.6%; 79.5 ± 7.5 years). Women had a higher risk of institutionalization than men (hazard ratio [HR], 1.21; 95% CI, 1.16-1.26) and lower mortality once institutionalized (HR, 0.61; 95% CI, 0.58-0.64), resulting in longer stays (median, 2.44 vs 1.47 years). Women also had lower overall mortality (HR, 0.72; 95% CI, 0.70-0.75). On average, women had lower yearly health care costs (-€1297; 95% CI, -€1597 to -€1086) but higher long-term care costs (€11,247; 95% CI, €10,462-€11,852) than men across care settings. While adjustment for age and institutionalization reduced the differences, they remained significant. In addition, women's long-term care costs increased more over time (€1129 per year; 95% CI, €899-€1308), whereas their health care costs decreased more (-€246 per year; 95% CI, -€394 to -€121). CONCLUSIONS AND IMPLICATIONS: Women lived longer with dementia than men and used more formal long-term care, both at home and in institutional settings. These findings highlight the need for care systems to account for sex-specific differences in care trajectories when planning and financing long-term dementia care.