Sentell Tetine L, Valcour Nicole, Ahn Hyeong Jun, Miyamura Jill, Nakamoto Beau, Chow Dominic, Masaki Kamal, Seto Todd B, Chen John J, Shikuma Cecilia
Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, Hawai'i.
J Am Geriatr Soc. 2015 Jan;63(1):158-64. doi: 10.1111/jgs.13182. Epub 2014 Dec 23.
Data on dementia in Native Hawaiians and many Asian subgroups in the United States are limited. Inpatients with dementia have higher costs, longer stays, and higher mortality than those without dementia. This study compared rates of inpatients with a dementia diagnosis for disaggregated Asian and Pacific Islanders (Native Hawaiian, Chinese, Japanese, Filipino) with those of whites according to age (18-59, 60-69, 70-79, 80-89, ≤90) for all adults hospitalized in Hawai'i between December 2006 and December 2010; 13,465 inpatients with a dementia diagnosis were identified using International Classification of Diseases, Ninth Revision, codes. Rates were calculated using population size denominators derived from the U.S. Census. In all age categories, Native Hawaiians had the highest unadjusted rates of inpatients with dementia and were more likely to have a dementia diagnosis at discharge at younger ages than other racial and ethnic groups. In adjusted models (controlling for sex, residence location, and insurer), Native Hawaiian inpatients aged 18 to 59 (aRR = 1.50, 95% CI = 0.84-2.69), 60 to 69 (aRR = 2.53, 95% CI = 1.74-3.68), 70 to 79 (aRR = 2.19, 95% CI = 1.78-2.69), and 80 to 89 (aRR = 2.53, 95% CI = 1.24-1.71) were significantly more likely to have dementia than whites, as were Japanese aged 70 to 79 (aRR = 1.30, 95% CI = 1.01-1.67), 80 to 89 (aRR = 1.29, 95% CI = 1.05-1.57), and 90 and older (aRR = 1.51, 95% CI = 1.24-1.85). Japanese aged 18 to 59 had were significantly less likely to have dementia than whites (aRR = 0.40, 95% CI = 0.17-0.94). These patterns have important public health and clinical care implications for Native Hawaiians and older Japanese populations. Future studies should consider whether preventable medical risk, caregiving, socioeconomic conditions, genetic disposition, or a combination of these factors are responsible for these findings.
关于美国夏威夷原住民和许多亚洲亚群体中痴呆症的数据有限。患有痴呆症的住院患者比没有痴呆症的患者费用更高、住院时间更长、死亡率更高。本研究比较了2006年12月至2010年12月期间在夏威夷住院的所有成年人中，按年龄（18 - 59岁、60 - 69岁、70 - 79岁、80 - 89岁、90岁及以上）划分的亚洲和太平洋岛民（夏威夷原住民、华裔、日裔、菲律宾裔）与白人中痴呆症诊断住院患者的比例；使用国际疾病分类第九版编码确定了13465例有痴呆症诊断的住院患者。比例是使用从美国人口普查得出的人口规模分母计算的。在所有年龄类别中，夏威夷原住民的痴呆症住院患者未调整比例最高，并且在较年轻的年龄出院时比其他种族和族裔群体更有可能被诊断为痴呆症。在调整模型中（控制性别、居住地点和保险公司），18至59岁的夏威夷原住民住院患者（调整后相对风险 = 1.50，95%置信区间 = 0.84 - 2.69）、60至69岁（调整后相对风险 = 2.53，95%置信区间 = 1.74 - 3.68）、70至79岁（调整后相对风险 = 2.19，95%置信区间 = 1.78 - 2.69）和80至89岁（调整后相对风险 = 2.53，95%置信区间 = 1.24 - 1.71）患痴呆症的可能性显著高于白人，70至79岁的日裔（调整后相对风险 = 1.30，95%置信区间 = 1.01 - 1.67）、80至89岁（调整后相对风险 = 1.29，95%置信区间 = 1.05 - 1.57）和90岁及以上（调整后相对风险 = 1.51，95%置信区间 = 1.24 - 1.85）也是如此。18至59岁的日裔患痴呆症的可能性显著低于白人（调整后相对风险 = 0.40，95%置信区间 = 0.17 - 0.94）。这些模式对夏威夷原住民和老年日裔人群具有重要的公共卫生和临床护理意义。未来的研究应考虑可预防的医疗风险、护理、社会经济状况、遗传倾向或这些因素的组合是否是这些发现的原因。
