Cognitive impairment and hospital admission risk among community-dwelling adults in the MAUCO cohort

BACKGROUND: Understanding whether cognitive impairment increases the risk of hospital admissions is essential for preventing burdensome care. However, most evidence focuses on people with dementia diagnosis and comes primarily from Europe and North America. OBJECTIVE: To evaluate the association between screening-based cognitive impairment and the incidence of hospital admissions and re-admissions, and to identify factors associated with hospital admission risk in the MAUCO cohort, the first prospective cohort from central-southern Chile. MATERIALS AND METHODS: A prospective population-based study including adults (38-74 years) from the MAUCO cohort with a Mini-Mental State Examination (MMSE) and/or an Addenbrooke's Cognitive Examination-Revised (ACE-R) test at baseline. Hospital admissions were identified through administrative records. Multivariate Cox and negative binomial regressions with Inverse Probability Treatment Weighting were used to estimate associations between cognitive impairment and (1) hospital admission (2), 30-day all-cause readmission and (3) number of hospital admissions. RESULTS: Of 9066 participants with an MMSE, 6776 also completed an ACE-R. Mean age was 53.3 years, 54.5% female, and 19.8% had less than six years of education. Cognitive impairment prevalence was 19.7% by MMSE and 19.3% by ACE-R. Over a mean 7.8 years follow-up, 23.1% had 1+ hospital admissions, and 12.1% of them experienced a readmission. People with MMSE-defined cognitive impairment had a 40% higher incidence rate of hospital admissions than age- and sex-weighted controls without impairment (IRR 1.40; 95% CI 1.18-1.66), but readmission rates did not differ. Diabetes and self‑reported health status were the strongestpredictors of hospital admissions and readmissions, whereas associations with cognitive status varied by cognitive instrument, impairment category, and hospital admission outcome. CONCLUSIONS: MMSE-based cognitive impairment was associated with higher hospital admission rates, whereasACE-R-based imparimen showed a less clear pattern. Chronic conditions and disease burden may play a more important drivers of hospital use than cognitive status alone.