Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
J Epidemiol Community Health. 2017 Jun;71(6):576-583. doi: 10.1136/jech-2016-207809. Epub 2017 Mar 1.
To determine whether hospital admission for autoimmune disease is associated with an elevated risk of future admission for dementia.
Retrospective, record-linkage cohort study using national hospital care and mortality administrative data, 1999-2012. Cohorts of people admitted to hospital with a range of autoimmune diseases were constructed, along with a control cohort, and followed forward in time to see if they developed dementia. 1 833 827 people were admitted to hospital with an autoimmune disease; the number of people in cohorts for each autoimmune disease ranged from 1019 people in the Goodpasture's syndrome cohort, to 316 043 people in the rheumatoid arthritis cohort.
The rate ratio for dementia after admission for an autoimmune disease, compared with the control cohort, was 1.20 (95% CI 1.19 to 1.21). Where dementia type was specified, the rate ratio was 1.06 (1.04 to 1.08) for Alzheimer's disease and 1.28 (1.26 to 1.31) for vascular dementia. Of 25 autoimmune diseases studied, 18 showed significant positive associations with dementia at p<0.05 (with 14 significant at p<0.001) including Addison's disease (1.48, 1.34 to 1.64), multiple sclerosis (1.97, 1.88 to 2.07), psoriasis (1.29, 1.25 to 1.34) and systemic lupus erythematosus (1.46, 1.32 to 1.61).
The associations with vascular dementia may be one component of a broader association between autoimmune diseases and vascular damage. Though findings were significant, effect sizes were small. Clinicians should be aware of the possible coexistence of autoimmune disease and dementia in individuals. Further studies are needed to confirm or refute our findings and to explore possible mechanisms mediating any elevation of risk.
确定自身免疫性疾病住院是否与未来痴呆住院风险增加相关。
采用全国医院护理和死亡率管理数据进行回顾性记录链接队列研究，时间为 1999 年至 2012 年。构建了一系列患有各种自身免疫性疾病的人群队列，并构建了对照组，然后向前随访以观察他们是否患上痴呆症。共有 1833827 人因自身免疫性疾病住院；每种自身免疫性疾病的队列人数从 Goodpasture 综合征队列的 1019 人到类风湿关节炎队列的 316043 人不等。
与对照组相比，因自身免疫性疾病住院后痴呆的发病率比为 1.20（95%可信区间 1.19 至 1.21）。在指定痴呆类型的情况下，阿尔茨海默病的发病率比为 1.06（1.04 至 1.08），血管性痴呆为 1.28（1.26 至 1.31）。在所研究的 25 种自身免疫性疾病中，18 种疾病与痴呆症显著相关（p<0.05），其中 14 种疾病具有显著相关性（p<0.001），包括 Addison 病（1.48，1.34 至 1.64）、多发性硬化症（1.97，1.88 至 2.07）、银屑病（1.29，1.25 至 1.34）和系统性红斑狼疮（1.46，1.32 至 1.61）。
与血管性痴呆的关联可能是自身免疫性疾病与血管损伤之间更广泛关联的一个组成部分。尽管结果具有统计学意义，但效应大小较小。临床医生应意识到个体中自身免疫性疾病和痴呆症可能同时存在。需要进一步研究来证实或反驳我们的发现，并探讨可能介导任何风险增加的机制。
