Can dementia become the most prevalent disease at the time of death in Germany? Projections up to the year 2060 for the five most important diseases at the time of death

Data on the burden of disease in the last years of life are an important basis for health policy decisions and the allocation of health care resources. Since dementia is one of the most expensive diseases, we ask the question whether dementia will ever be the most common disease at the time of death in older people? While international cause-of-death statistics report the underlying cause of death, dementia patients generally die from complications or sequelae. Instead of using causes of death, we identified the five most prevalent disease categories at age 70 and older at the time of death using German health claims data from 2004 to 2007 and 2014-2017, and combined their prevalence rates with the estimated number of deaths at age 70 and older up to the year 2060. We developed two scenarios, first, to represent the impact of population aging and increasing life expectancy. Second, to additionally examine the impact of morbidity trends among those who died. We found that dementia was already the most prevalent disease at the time of death among German women aged 70 years and older in 2014-2017, while it was still in fifth place among German men. Population aging and increasing life expectancy will result in dementia ranking first among women and second among men if the morbidity profile at the time of death remains constant. Extrapolating the observed time trends into the projections, cancer will be the most prevalent disease at the time of death for both sexes. Dementia will be second for women, and third for men after IHD. In addition to projections of causes of death, we also need projections of diseases at the time of death to better prepare for the needs of people in their final stages of life.