Associated factors for dysphagia in Alzheimer’s patients: a retrospective nationwide inpatient database study

The study aimed to identify the prevalence, associated factors, and outcomes associated with dysphagia in hospitalized Alzheimer’s disease (AD) patients. This large-scale retrospective cohort analysis examined 943,053 hospitalization records of patients aged ≥ 65 years with AD patients using the U.S. Nationwide Inpatient Sample (NIS) database from 2010 to 2019. Our comprehensive analytical framework incorporated multiple dimensions: sociodemographic characteristics (age, sex, race, insurance status), clinical parameters (comorbidity profiles, admission type), institutional factors (hospital size, location, teaching status), and outcome measures (length of stay(LOS), hospitalization costs, in-hospital mortality). Logistic regression modeling was conducted to identify associated factors contributing to the development of dysphagia in the Alzheimer’s disease cohort. Dysphagia prevalence in hospitalized AD patients was 9.01%, steadily increasing from 7.2% in 2010 to 9.96% in 2019. Dysphagia was associated with prolonged LOS (median 6 days vs. 4 days; p < 0.001), higher in-hospital mortality (6.70% vs. 4.54%; p < 0.001), and elevated hospitalization costs ($36,446 vs. $25,513; p < 0.001). Major associated factors included advanced age (OR = 1.087 for age 75–84; OR = 1.342 for age ≥ 85), Black race (OR = 1.277), Asian/Pacific Islander ethnicity (OR = 1.668), treatment in urban hospitals (OR = 1.422), and large teaching institutions (OR = 1.105). Conversely, female gender (OR = 0.767; 95% CI: 0.754–0.780) and elective admissions (OR = 0.888; 95% CI: 0.859–0.918) were protective factors. Dysphagia risk was strongly associated with several comorbidities, including paralysis (OR = 2.820), weight loss and pneumonia (both OR = 2.188), stroke (OR = 1.745), and fluid and electrolyte disorders (OR = 1.581). Additional significant clinical comorbidities included peptic ulcer disease, chronic pulmonary disease, delirium, and congestive heart failure. Dysphagia prevalence in hospitalized AD patients has risen significantly over the past decade, substantially impacting clinical outcomes and healthcare utilization. Early screening protocols and multidisciplinary management are crucial for this vulnerable population to reduce outcomes associated with dysphagia, improve prognosis, and minimize healthcare costs.