Trends in 5-year community management of persons with dementia in Korea, 2003–2016

TL;DR

This study examines how well Korea managed dementia patients in the community over five years from 2003 to 2016, showing improvements and narrowing disparities in care.

Contribution

The study introduces the 5-year community management rate as a novel indicator for evaluating dementia care systems and policy effectiveness.

Findings

The 5-year community management rate for dementia improved steadily from 2003 to 2016.

Disparities in care by sex, income, and residence decreased over time.

Patients diagnosed in neurology or psychiatry had consistently higher management rates than those in other departments.

Abstract

The community 5-year management rate, defined as the proportion of patients with dementia who remain in community-based informal care without long-term institutionalization 5 years after diagnosis reflects the effectiveness of national dementia strategies and social care systems.

To examine national trends in the 5-year community management rate of dementia and assess whether disparities in dementia care outcomes have changed by demographic, socioeconomic, and clinical characteristics.

This retrospective, population-based cohort study used a customized research database from the Korean National Health Insurance Service (2003–2021). Subgroup analyses were performed by age, sex, income, region (metropolitan vs. non-metropolitan), Charlson Comorbidity Index, diagnosing department (neurology/psychiatry vs other). The study population included patients newly diagnosed with dementia per annum during the study period. The primary outcome was the proportion of patients remaining in community 5 five years after diagnosis, without long-term institutionalization. Secondary outcomes included disparities in management rates across subgroups.

Overall 779,558 patients were included. The 5-year community management rate showed continued improvement over time. Disparities by sex, residence, and income narrowed steadily between 2003 and 2016. Patients diagnosed in neurology or psychiatry consistently had higher management rates than those diagnosed in other departments, and this gap widened over time.

Community management rates are influenced by social and personal factors. While disparities by sex, income, and residence decreased, persistent differences by comorbidity and diagnosing department highlight the need for targeted policy interventions. The 5-year community management rate may serve as a meaningful indicator of real-world dementia care outcomes.

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