Netherlands Interdisciplinary Demographic Institute (NIDI), The Hague, The Netherlands.
Eur J Epidemiol. 2011 May;26(5):395-403. doi: 10.1007/s10654-011-9553-x. Epub 2011 Feb 20.
Improved health may extend or shorten the duration of cognitive impairment by postponing incidence or death. We assess the duration of cognitive impairment in the US Health and Retirement Study (1992-2004) by self reported BMI, smoking and levels of education in men and women and three ethnic groups. We define multistate life tables by the transition rates to cognitive impairment, recovery and death and estimate Cox proportional hazard ratios for the studied determinants. 95% confidence intervals are obtained by bootstrapping. 55 year old white men and women expect to live 25.4 and 30.0 years, of which 1.7 [95% confidence intervals 1.5; 1.9] years and 2.7 [2.4; 2.9] years with cognitive impairment. Both black men and women live 3.7 [2.9; 4.5] years longer with cognitive impairment than whites, Hispanic men and women 3.2 [1.9; 4.6] and 5.8 [4.2; 7.5] years. BMI makes no difference. Smoking decreases the duration of cognitive impairment with 0.8 [0.4; 1.3] years by high mortality. Highly educated men and women live longer, but 1.6 years [1.1; 2.2] and 1.9 years [1.6; 2.6] shorter with cognitive impairment than lowly educated men and women. The effect of education is more pronounced among ethnic minorities. Higher life expectancy goes together with a longer period of cognitive impairment, but not for higher levels of education: that extends life in good cognitive health but shortens the period of cognitive impairment. The increased duration of cognitive impairment in minority ethnic groups needs further study, also in Europe.
健康状况的改善可能会通过推迟发病或死亡来延长或缩短认知障碍的持续时间。我们通过自我报告的 BMI、吸烟和教育水平来评估美国健康与退休研究（1992-2004 年）中男性和女性以及三个族裔的认知障碍持续时间。我们通过向认知障碍、恢复和死亡的转移率来定义多状态生命表，并估计研究决定因素的 Cox 比例风险比。95%置信区间通过自举法获得。55 岁的白人男性和女性预计分别有 25.4 年和 30.0 年的寿命，其中 1.7 年（95%置信区间 1.5；1.9 年）和 2.7 年（2.4；2.9 年）患有认知障碍。黑人男性和女性比白人多患有认知障碍 3.7 年（2.9；4.5 年），西班牙裔男性和女性多患有认知障碍 3.2 年（1.9；4.6 年）和 5.8 年（4.2；7.5 年）。BMI 没有区别。吸烟通过高死亡率使认知障碍的持续时间减少 0.8 年（0.4；1.3 年）。受教育程度高的男性和女性寿命更长，但患有认知障碍的时间比受教育程度低的男性和女性短 1.6 年（1.1；2.2 年）和 1.9 年（1.6；2.6 年）。教育的影响在少数民族中更为明显。较高的预期寿命与认知障碍的持续时间较长有关，但与较高的教育水平无关：这延长了认知健康的寿命，但缩短了认知障碍的持续时间。少数族裔群体认知障碍持续时间的增加需要进一步研究，在欧洲也是如此。
