| 제목 |
Difference of the Application for Dementia Special Grade According to Regional and Education Level |
| 소속 |
Gangnam Severance Hospital, Yonsei University College of Medicine, Department of Rehabilitation Medicine1, National Health Insurance Service Ilsan Hospital, Department of Rehabilitation Medicine2, Guro Hospital, Korea University, Department of Rehabilitation Medicine3, National Health Insurance Service Ilsan Hospital, Department of Neurology, Dementia Center4, National Health Insurance Service Ilsan Hospital, Research and analysis team5 |
| 저자 |
Han Eol Cho1*, Wooin Choi2, Seung Nam Yang3, Jong Hun Kim4, Hyun Sun Lim 5, Hyoung Seop Kim2† |
Introduction
We analyzed the long-term care insurance service(LTCI) in Korea to investigate whether the timing of the application for Dementia Special Grade(DSG) is different according to socioeconomic status (SES) such as regional differences and education level.
Methods
We collected DSG data from 2014 to 2016. The DSG patients were classified into two categories according to their residence, urban and countryside. We also examined patients who has received treatment for dementia for more than 6 months and those who have received anti-dementia medication in order to confirm the treatment of dementia by region. In addition, we divided the level of patients’ education into five categories: illiteracy, only literacy without formal education, 1-6 years, 6-12 years, and more than 12 years of formal education. Alzheimer 's and vascular dementia were sub-grouped to identify differences by dementia type.
Results
A total of 27,611 patients were treated for dementia for more than 6 months. Of these patients, 56.56%(15618) were living in the city and 43.44% (11993) were living in the country side. Of the 41728 patients who received anti-dementia medication, 55.87% (23313) were living in the city, and among the people living in the city, 44.13%(18415) were diagnosed with dementia and at DSG approval. Urban residents were diagnosed and approved DSG significantly earlier than rural residents(Figure 1). We found that the age at the time of dementia diagnosis and the time of DSG application were faster as the education level was higher. Similar results were obtained in the sub-group of Alzheimer’s dementia and vascular dementia(Figure 2).
Discussion
1) To apply for DSG, medical staffs with professional training for the diagnosis of dementia with advanced diagnostic tools such as MRI are necessary. If there are hospitals that specializes in dementia, people can easily get tested for dementia. Therefore, it can be assumed that people living in large cities with hospitals specializing in dementia have an inclination towards earlier diagnosis of dementia.
2) Our results were in conflict with the previous study which states that lower level of education is correlated with higher risk of dementia. We considered few possible explanation for this conflict. First, the higher the level of education, the easier it will be for the patients to discover their abnormal symptoms that occur with the onset of dementia. In other words, the patients with higher the level of education will have greater functional status, so the caregivers could be more sensitive to detect cognitive decline. Second, it might be due to cognitive reserve. Many studies have shown that the patients with greater cognitive reserve capacity shows faster cognitive decline after the onset of dementia. Patients with high levels of education may have more rapid cognitive decline after the onset of dementia.
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Figure 1. Difference between urban and rural area
Figure 2. Age at the diagnosis of dementia and application of DSG according to education level
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