Gilsanz Paola, Mayeda Elizabeth Rose, Glymour M Maria, Quesenberry Charles P, Whitmer Rachel A
Division of Research, Kaiser Permanente, Oakland, California.
Department of Epidemiology and Biostatistics, University of California, San Francisco.
JAMA Neurol. 2017 Sep 1;74(9):1056-1062. doi: 10.1001/jamaneurol.2017.1553.
Birth in a group of predominantly southern US states is robustly linked to increased stroke risk. Given the role of cerebrovascular disease in dementia risk, geographic patterning may also occur for dementia incidence.
To determine whether birth in 9 high stroke mortality states (HSMSs) is associated with dementia in a diverse cohort of individuals living in Northern California.
DESIGN, SETTING, AND PARTICIPANTS: An observational cohort study included 7423 members of Kaiser Permanente Northern California (KPNC), an integrated health care delivery system, with health survey and clinical examination data available. Data were collected between 1964 and 1973 when the individuals were middle-aged and 1996 and 2015 when participants were in later life.
Self-reported state of birth in an HSMS (top quintile of states for stroke mortality).
Dementia diagnoses obtained from electronic health records from January 1, 1996, to October 15, 2015. Place of birth, race, educational level, and midlife vascular risk factors data were collected between 1964 and 1973.
Of the 7423 persons included in the analysis, 4049 (54.5%) were women; 1354 (18.2%) were black. The mean (SD) age of study participants at their first visit between 1963 and 1974 was 42.94 (1.73) years and mean (SD) age at the beginning of follow-up for dementia in 1996 was 71.14 (2.72) years. Dementia was diagnosed in 2254 (30.4%) of the participants and was more common among those born in an HSMS than those born outside of one (455 [39.0%] vs 1799 [28.8%]). Birth in an HSMS was 9.6 times more common for black participants (795 [58.7%]) than nonblack participants (371 [6.1%]). Overall, birth in an HSMS was associated with a 28% higher risk of dementia (adjusted hazard ratio [aHR], 1.28; 95% CI, 1.13-1.46) adjusted for age, sex, and race. Compared with nonblack persons born outside of an HSMS, black individuals born in an HSMS had the highest dementia risk (aHR, 1.67; 95% CI, 1.48-1.88), followed by black individuals not born in an HSMS (aHR, 1.48; 95% CI, 1.28-1.72), and nonblack persons born in an HSMS had a 46% increased risk (aHR, 1.46; 95% CI, 1.23-1.74). Cumulative 20-year dementia risks at age 65 years were 30.13% (95% CI, 26.87%-32.93%) and 21.80% (95% CI, 20.51%-22.91%) for individuals born in and outside an HSMS, respectively.
To our knowledge, this is the first study to date of place of birth and incident dementia and shows increased risk for individuals born in an HSMS, even though all participants subsequently resided in California. Birth in an HSMS was common among black participants. Place of birth has enduring consequences for dementia risk and may be a major contributor to racial disparities in dementia.
在美国南部主要几个州出生与中风风险增加密切相关。鉴于脑血管疾病在痴呆症风险中的作用，痴呆症发病率可能也存在地理分布模式。
确定在9个中风死亡率高的州（HSMSs）出生是否与居住在北加利福尼亚的不同个体群体患痴呆症有关。
设计、地点和参与者：一项观察性队列研究纳入了北加利福尼亚凯撒医疗集团（KPNC）的7423名成员，该集团是一个综合医疗服务系统，有健康调查和临床检查数据。数据收集时间为1964年至1973年（当时个体处于中年）以及1996年至2015年（参与者处于晚年）。
自我报告在HSMS出生的州（中风死亡率最高的五分之一州）。
1996年1月1日至2015年10月15日从电子健康记录中获得的痴呆症诊断。1964年至1973年收集了出生地、种族、教育水平和中年血管危险因素数据。
纳入分析的7423人中，4049人（54.5%）为女性；1354人（18.2%）为黑人。研究参与者在1963年至1974年首次就诊时的平均（标准差）年龄为42.94（1.73）岁，1996年痴呆症随访开始时的平均（标准差）年龄为71.14（2.72）岁。2254名（30.4%）参与者被诊断为痴呆症，出生在HSMS的参与者比未出生在HSMS的参与者更常见（455人[39.0%]对1799人[28.8%]）。黑人参与者在HSMS出生的比例（795人[58.7%]）是非黑人参与者（371人[6.1%]）的9.6倍。总体而言，在调整年龄、性别和种族后，出生在HSMS与痴呆症风险高28%相关（调整后风险比[aHR]，1.28；95%置信区间，1.13 - 1.46）。与出生在HSMS以外的非黑人相比，出生在HSMS的黑人患痴呆症风险最高（aHR，1.67；95%置信区间，1.48 - 1.88），其次是未出生在HSMS的黑人（aHR，1.48；95%置信区间，1.28 - 1.72），出生在HSMS的非黑人患痴呆症风险增加46%（aHR，1.46；95%置信区间，1.23 - 1.74）。65岁时累积20年痴呆症风险，出生在HSMS的个体为30.13%（95%置信区间，26.87% - 32.93%），出生在HSMS以外的个体为21.80%（95%置信区间，20.51% - 22.91%）。
据我们所知，这是迄今为止关于出生地与新发痴呆症的首次研究，表明出生在HSMS的个体风险增加，尽管所有参与者随后都居住在加利福尼亚。在黑人参与者中，出生在HSMS很常见。出生地对痴呆症风险有持久影响，可能是痴呆症种族差异的主要原因。
