Trends and Disparities in Dementia- and Sepsis-Related Mortality in Older U.S. Adults (1999-2020).

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INTRODUCTION: This observational study evaluated demographic and regional disparities in mortality due to dementia with comorbid sepsis among older adults (≥65 years) in the United States from 1999 to 2020. METHODS: We analyzed death certificate data from the CDC WONDER Multiple Cause of Death database (1999-2020). Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated and standardized to the 2000 U.S. POPULATION: Temporal trends were assessed using Joinpoint regression to estimate annual percentage change (APC) and average annual percent change (AAPC). Analyses were stratified by age, sex, race/ethnicity, geographic region, and urban-rural classification. RESULTS: Between 1999 and 2020, dementia with comorbid sepsis accounted for 284,645 deaths, yielding an overall AAMR of 30.8 (95% confidence interval: 30.7-30.9). Overall mortality remained stable (AAPC: 0.20%; 95% CI: -0.19 to 0.60). Males had higher mortality than females (AAMR: 31.8 vs. 30.0). Non-Hispanic Black individuals experienced the greatest burden (AAMR: 51.8), whereas Hispanic and non-Hispanic Asian/Pacific Islander populations demonstrated the steepest mortality increases. Crude mortality was highest among adults aged ≥85 years (136.1 per 100,000), while the largest relative increase occurred in those aged 75-84 years. The South exhibited the highest regional mortality (AAMR: 35.8), and rural areas showed elevated rates (AAMR: 31.7). CONCLUSION: Although mortality remained stable, disparities persist across demographic and geographic subgroups. Targeted interventions are needed to reduce inequities and mitigate mortality associated with dementia and sepsis in older adults.

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