Research School of Population Health, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra, Australia.
J Alzheimers Dis. 2018;61(1):125-134. doi: 10.3233/JAD-170079.
We have a poor understanding of whether dementia clusters geographically, how this occurs, and how dementia may relate to socio-demographic factors. To shed light on these important questions, this study aimed to compute a dementia risk score for individuals to assess spatial variation of dementia risk, identify significant clusters (hotspots), and explore their association with socioeconomic status. We used clinical records from 16 general practices (468 Statistical Area level 1 s, N = 14,746) from the city of west Adelaide, Australia for the duration of 1 January 2012 to 31 December 2014. Dementia risk was estimated using The Australian National University-Alzheimer's Disease Risk Index. Hotspot analyses were applied to examine potential clusters in dementia risk at small area level. Significant hotspots were observed in eastern and southern areas while coldspots were observed in the western area within the study perimeter. Additionally, significant hotspots were observed in low socio-economic communities. We found dementia risk scores increased with age, sex (female), high cholesterol, no physical activity, living alone (widow, divorced, separated, or never married), and co-morbidities such as diabetes and depression. Similarly, smoking was associated with a lower dementia risk score. The identification of dementia risk clusters may provide insight into possible geographical variations in risk factors for dementia and quantify these risks at the community level. As such, this research may enable policy makers to tailor early prevention strategies to the correct individuals within their precise locations.
我们对痴呆症是否在地理上聚集、这种情况是如何发生的以及痴呆症与社会人口因素的关系知之甚少。为了阐明这些重要问题，本研究旨在为个人计算痴呆症风险评分，以评估痴呆症风险的空间变化，识别显著聚集（热点），并探索其与社会经济地位的关系。我们使用了澳大利亚阿德莱德市 16 家普通诊所（468 个统计区 1 级，N=14746）在 2012 年 1 月 1 日至 2014 年 12 月 31 日期间的临床记录。使用澳大利亚国立大学-阿尔茨海默病风险指数来估计痴呆症风险。热点分析被应用于检验小区域内痴呆症风险的潜在聚集。在研究范围内，在东部和南部地区观察到显著的热点，而在西部观察到冷点。此外，在社会经济地位较低的社区也观察到显著的热点。我们发现痴呆症风险评分随年龄、性别（女性）、高胆固醇、缺乏体育活动、独居（丧偶、离婚、分居或未婚）以及糖尿病和抑郁症等合并症而增加。同样，吸烟与痴呆症风险评分较低有关。痴呆症风险聚类的识别可以深入了解痴呆症风险因素的可能地理差异，并在社区层面量化这些风险。因此，这项研究可以使政策制定者根据个人的具体位置为他们量身定制早期预防策略。
