Shadlen Marie-Florence, Siscovick David, Fitzpatrick Annette L, Dulberg Corinne, Kuller Lewis H, Jackson Sharon
Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington Harborview Medical Center, 325 9th Avenue, Seattle, WA 98104, USA.
J Am Geriatr Soc. 2006 Jun;54(6):898-905. doi: 10.1111/j.1532-5415.2006.00747.x.
To compare dementia risks of elderly black and white subjects and to determine whether differences in education and cognitive test scores contribute to the inconsistency in reported differences between these groups.
Longitudinal, 6-year follow-up.
Two thousand seven hundred eighty-six older black and white subjects in the Cardiovascular Health Study.
Age, education (>10 years vs < or =10 years), Modified Mini-Mental State Examination score (3MS, < or =85 vs >85). Potential confounders were sex, depression, apolipoprotein E4 genotype, vascular disease, and baseline magnetic resonance imaging changes.
White subjects with low education and black subjects with high education had twice the risk of dementia of white subjects with high education (95% confidence interval (CI)=1.5-2.4 and 95% CI=1.4-2.7); black subjects with low education had five times the risk of dementia (95% CI=3.4-7.7). Likewise, for subjects with low 3MSE scores, black subjects had 6.7 times the risk of dementia (95% CI=4.7-9.7) and white subjects had 2.7 times the risk of dementia (95% CI=2.2-3.5) as white subjects with high 3MSE scores. Finally, in Cox models, there was no significant black-white difference in dementia risk after adjustment for all confounders and baseline 3MSE.
Black race was associated with greater dementia risk even after adjustment for education and other potential confounders. This black-white difference in dementia risk was markedly attenuated after adjustment for baseline cognitive screening scores. The apparent race effect may reflect gaps in the quality of education or differences in the trajectory of impaired cognitive function experienced by the two groups. Future investigations might take these findings into consideration for the design of studies evaluating black-white differences in dementia risk.
比较老年黑人和白人患痴呆症的风险，并确定教育程度和认知测试分数的差异是否导致了这两组人群报告差异的不一致。
纵向研究，为期6年的随访。
心血管健康研究中的2786名老年黑人和白人受试者。
年龄、教育程度（>10年vs≤10年）、改良简易精神状态检查表评分（3MS，≤85分vs>85分）。潜在混杂因素包括性别、抑郁、载脂蛋白E4基因型、血管疾病和基线磁共振成像变化。
低教育程度的白人受试者和高教育程度的黑人受试者患痴呆症的风险是高教育程度白人受试者的两倍（95%置信区间[CI]=1.5-2.4，95%CI=1.4-2.7）；低教育程度的黑人受试者患痴呆症的风险是其五倍（95%CI=3.4-7.7）。同样，对于3MSE评分低的受试者，黑人受试者患痴呆症的风险是3MSE评分高的白人受试者的6.7倍（95%CI=4.7-9.7），白人受试者是其2.7倍（95%CI=2.2-3.5）。最后，在Cox模型中，调整所有混杂因素和基线3MSE后，痴呆症风险在黑人和白人之间没有显著差异。
即使在调整教育程度和其他潜在混杂因素后，黑人种族患痴呆症的风险仍然更高。在调整基线认知筛查分数后，黑人和白人在痴呆症风险上的差异明显减弱。这种明显的种族效应可能反映了教育质量的差距或两组经历的认知功能受损轨迹的差异。未来的研究在设计评估黑人和白人痴呆症风险差异的研究时可能会考虑这些发现。
