van Bussel Emma F, Richard Edo, Arts Derk L, Nooyens Astrid C J, Coloma Preciosa M, de Waal Margot W M, van den Akker Marjan, Biermans Marion C J, Nielen Markus M J, van Boven Kees, Smeets Hugo, Matthews Fiona E, Brayne Carol, Busschers Wim B, van Gool Willem A, Moll van Charante Eric P
Department of General Practice, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands.
PLoS Med. 2017 Mar 7;14(3):e1002235. doi: 10.1371/journal.pmed.1002235. eCollection 2017 Mar.
Recent reports have suggested declining age-specific incidence rates of dementia in high-income countries over time. Improved education and cardiovascular health in early age have been suggested to be bringing about this effect. The aim of this study was to estimate the age-specific dementia incidence trend in primary care records from a large population in the Netherlands.
A dynamic cohort representative of the Dutch population was composed using primary care records from general practice registration networks (GPRNs) across the country. Data regarding dementia incidence were obtained using general-practitioner-recorded diagnosis of dementia within the electronic health records. Age-specific dementia incidence rates were calculated for all persons aged 60 y and over; negative binomial regression analysis was used to estimate the time trend. Nine out of eleven GPRNs provided data on more than 800,000 older people for the years 1992 to 2014, corresponding to over 4 million person-years and 23,186 incident dementia cases. The annual growth in dementia incidence rate was estimated to be 2.1% (95% CI 0.5% to 3.8%), and incidence rates were 1.08 (95% CI 1.04 to 1.13) times higher for women compared to men. Despite their relatively low numbers of person-years, the highest age groups contributed most to the increasing trend. There was no significant overall change in incidence rates since the start of a national dementia program in 2003 (-0.025; 95% CI -0.062 to 0.011). Increased awareness of dementia by patients and doctors in more recent years may have influenced dementia diagnosis by general practitioners in electronic health records, and needs to be taken into account when interpreting the data.
Within the clinical records of a large, representative sample of the Dutch population, we found no evidence for a declining incidence trend of dementia in the Netherlands. This could indicate true stability in incidence rates, or a balance between increased detection and a true reduction. Irrespective of the exact rates and mechanisms underlying these findings, they illustrate that the burden of work for physicians and nurses in general practice associated with newly diagnosed dementia has not been subject to substantial change in the past two decades. Hence, with the ageing of Western societies, we still need to anticipate a dramatic absolute increase in dementia occurrence over the years to come.
近期报告显示，高收入国家特定年龄组的痴呆发病率随时间呈下降趋势。有人认为，早年教育水平的提高和心血管健康状况的改善带来了这种影响。本研究的目的是根据荷兰大量人群的初级保健记录，估算特定年龄组的痴呆发病率趋势。
利用全国全科医疗登记网络（GPRN）的初级保健记录，组成了一个代表荷兰人口的动态队列。通过电子健康记录中全科医生记录的痴呆诊断信息获取痴呆发病率数据。计算了所有60岁及以上人群的特定年龄痴呆发病率；采用负二项回归分析估算时间趋势。在11个GPRN中，有9个提供了1992年至2014年期间超过80万老年人的数据，相当于超过400万人年和23186例痴呆症发病病例。痴呆发病率的年增长率估计为2.1%（95%CI 0.5%至3.8%），女性的发病率是男性的1.08倍（95%CI 1.04至1.13）。尽管人年数相对较少，但最高年龄组对增长趋势的贡献最大。自2003年国家痴呆症计划启动以来，发病率没有显著的总体变化（-0.025；95%CI -0.062至0.011）。近年来患者和医生对痴呆症的认识提高，可能影响了电子健康记录中全科医生对痴呆症的诊断，在解释数据时需要考虑到这一点。
在荷兰大量具有代表性人群的临床记录中，我们没有发现荷兰痴呆发病率呈下降趋势的证据。这可能表明发病率真正稳定，或者是检测增加与实际下降之间的平衡。无论这些发现背后的确切发病率和机制如何，它们都表明，在过去二十年中，全科医疗中与新诊断痴呆症相关的医生和护士的工作负担没有发生实质性变化。因此，随着西方社会的老龄化，我们仍需预计未来几年痴呆症的绝对发病率将大幅上升。
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