US dementia death rates remain above pre-pandemic levels through 2022

US dementia death rates remain above pre-pandemic levels through 2022

The number of deaths attributed to dementia among U.S. Adults age 65 and older remains higher than levels seen before the COVID-19 pandemic, according to data from the National Center for Health Statistics. In 2022, there were 288,436 deaths where dementia was the underlying cause, a category that includes Alzheimer disease, vascular dementia, unspecified dementia, and other degenerative diseases of the nervous system.

Age-adjusted death rates were stable between 2018 and 2019, but surged by 10.2% between 2019 and 2020, rising from 520.1 to 572.9 deaths per 100,000 standard population. While overall rates declined to 548.9 between 2020 and 2022, they have not returned to the 2018 or 2019 levels.

Gender and Racial Disparities

Dementia death rates were higher for women than for men throughout the entire 2018–2022 period. The increase during the first year of the pandemic was more pronounced for women, whose rate rose 11.8% (from 567.7 to 634.5) compared to a 7.1% increase for men (from 440.5 to 471.6). Following the 2020 peak, death rates for women declined annually, reaching 599.6 in 2022. Men's rates declined from 2020 to 2021 and remained stable through 2022 at 464.6.

The data also reveals disparities across racial and ethnic groups. From 2018 to 2022, death rates were higher for White adults compared to Black and Hispanic adults. All groups saw stable rates between 2018 and 2019, followed by increases in 2020:

• White adults: 555.3 to 608.0
• Black adults: 502.9 to 582.7
• Hispanic adults: 370.6 to 425.8

While rates for Black and White adults declined from 2020 to 2022, rates for Hispanic adults remained stable during that same window.

Shifts in Place of Death

The environment where patients die from dementia shifted significantly over the five-year period. Nursing homes and long-term care facilities saw a decline in deaths, dropping from 53.6% in 2018 to 44.6% in 2022. Conversely, deaths occurring at home increased from 23.7% to 30.4%.

Other changes include a slight increase in hospice facility deaths, which rose from 6.4% to 6.6%, and a slight decline in hospital deaths from 8.2% to 7.6%.

The Burden of Alzheimer's Disease

Alzheimer's disease is the most common cause of dementia. Official death certificates recorded 120,122 deaths from Alzheimer's in 2022. The disease has ranked as the seventh-leading cause of death since 2020, though 2023 data suggests it will likely return to the sixth-leading position. Between 2000 and 2022, reported deaths from Alzheimer's increased by more than 142%, even as deaths from heart disease, stroke, and HIV decreased.

The economic and social toll is substantial. In 2024, nearly 12 million unpaid caregivers provided an estimated 19.2 billion hours of care, a service valued at $413.5 billion. This reflects a trend where fewer caregivers are providing more care per person. Total estimated payments for health care, hospice, and long-term care for adults age 65 and older with dementia are $384 billion for 2025.

Government spending also reflects the severity of the condition. Average per-person Medicare payments for beneficiaries with Alzheimer's or other dementias are almost three times greater than for those without. Medicaid payments are more than 22 times greater.

Diagnosis and Future Outlook

Current estimates suggest 7.2 million Americans age 65 and older live with Alzheimer's dementia, a figure that could reach 13.8 million by 2060 without medical breakthroughs. Diagnosis remains a challenge, as brain changes often begin 20 years or more before symptoms appear. In some cases, glucose metabolism decreases up to 18 years and brain atrophy begins up to 13 years before symptom onset.

Medical professionals are increasingly identifying "mixed dementia," where an individual has brain changes from more than one cause. One autopsy study of 447 older people showed that 82% had Alzheimer's disease plus at least one other cause of dementia, while only 3% had Alzheimer's alone.

Despite these challenges, survey results show optimism. Most Americans believe early detection is important, and about two-thirds are aware of new medications that slow the progression of Alzheimer's. Many expressed hope for new treatments over the next decade.