Population incidence and associated mortality of urinary tract infection in people living with dementia

Helen Lai; Magdalena Kolanko; Lucia M Li; Megan E Parkinson; Niall J Bourke; Neil S N Graham; Michael C B David; Emma-Jane Mallas; Bowen Su; Sarah Daniels; Danielle Wilson; Mara Golemme; Claire Norman; Kirsten Jensen; Raphaella Jackson; Martin Tran; Paul S Freemont; David Wingfield; Tim Wilkinson; Edward W Gregg; Ioanna Tzoulaki; David J Sharp; Eyal Soreq

doi:10.1016/j.jinf.2024.106167

Population incidence and associated mortality of urinary tract infection in people living with dementia

J Infect. 2024 Apr 26;88(6):106167. doi: 10.1016/j.jinf.2024.106167. Online ahead of print.

Authors

Helen Lai¹, Magdalena Kolanko¹, Lucia M Li¹, Megan E Parkinson², Niall J Bourke³, Neil S N Graham¹, Michael C B David¹, Emma-Jane Mallas¹, Bowen Su⁴, Sarah Daniels¹, Danielle Wilson¹, Mara Golemme¹, Claire Norman⁵, Kirsten Jensen⁶, Raphaella Jackson⁶, Martin Tran⁶, Paul S Freemont⁶, David Wingfield⁷, Tim Wilkinson⁸, Edward W Gregg⁹, Ioanna Tzoulaki¹⁰, David J Sharp¹, Eyal Soreq¹¹

Affiliations

¹ UK Dementia Research Institute Care Research and Technology Centre (UK DRI CR&T) at Imperial College London and the University of Surrey, Imperial College London, White City Campus, 86 Wood Lane, London W12 0BZ, UK; Department of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK.
² UK Dementia Research Institute Care Research and Technology Centre (UK DRI CR&T) at Imperial College London and the University of Surrey, Imperial College London, White City Campus, 86 Wood Lane, London W12 0BZ, UK; Perioperative and Ageing Group, Imperial College London, South Kensington Campus, London SW7 2AZ, UK.
³ Department of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK; Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London SE5 8AB, UK.
⁴ Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, South Kensington Campus, London SW7 2AZ, UK.
⁵ UK Dementia Research Institute Care Research and Technology Centre (UK DRI CR&T) at Imperial College London and the University of Surrey, Imperial College London, White City Campus, 86 Wood Lane, London W12 0BZ, UK; Brook Green Medical Centre, Hammersmith and Fulham GP Partnership, Bute Gardens, London W6 7EG, UK.
⁶ UK Dementia Research Institute Care Research and Technology Centre (UK DRI CR&T) at Imperial College London and the University of Surrey, Imperial College London, White City Campus, 86 Wood Lane, London W12 0BZ, UK; Section of Structural and Synthetic Biology, Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK.
⁷ UK Dementia Research Institute Care Research and Technology Centre (UK DRI CR&T) at Imperial College London and the University of Surrey, Imperial College London, White City Campus, 86 Wood Lane, London W12 0BZ, UK; Department of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK; Brook Green Medical Centre, Hammersmith and Fulham GP Partnership, Bute Gardens, London W6 7EG, UK.
⁸ Centre for Clinical Brain Sciences, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
⁹ Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, South Kensington Campus, London SW7 2AZ, UK; School of Population Health, Royal College of Surgeons of Ireland, University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland.
¹⁰ Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, South Kensington Campus, London SW7 2AZ, UK; Biomedical Research Foundation Academy of Athens, 4 Soranou Ephessiou Street, Athens 115 27, Greece.
¹¹ UK Dementia Research Institute Care Research and Technology Centre (UK DRI CR&T) at Imperial College London and the University of Surrey, Imperial College London, White City Campus, 86 Wood Lane, London W12 0BZ, UK. Electronic address: e.soreq14@imperial.ac.uk.

PMID: 38679203
DOI: 10.1016/j.jinf.2024.106167

Abstract

Objectives: Urinary tract infections (UTIs) frequently cause hospitalisation and death in people living with dementia (PLWD). We examine UTI incidence and associated mortality among PLWD relative to matched controls and people with diabetes and investigate whether delayed or withheld treatment further impacts mortality.

Methods: Data were extracted for n = 2,449,814 people aged ≥ 50 in Wales from 2000-2021, with groups matched by age, sex, and multimorbidity. Poisson regression was used to estimate incidences of UTI and mortality. Cox regression was used to study the effects of treatment timing.

Results: UTIs in dementia (HR=2.18, 95 %CI [1.88-2.53], p < .0) and diabetes (1.21[1.01-1.45], p = .035) were associated with high mortality, with the highest risk in individuals with diabetes and dementia (both) (2.83[2.40-3.34], p < .0) compared to matched individuals with neither dementia nor diabetes. 5.4 % of untreated PLWD died within 60 days of GP diagnosis-increasing to 5.9 % in PLWD with diabetes.

Conclusions: Incidences of UTI and associated mortality are high in PLWD, especially in those with diabetes and dementia. Delayed treatment for UTI is further associated with high mortality.

Keywords: Anti-bacterial agents; Comorbidity; Dementia; Diabetes mellitus; Incidence; Mortality; Population health; Therapeutics; Urinary tract infections.