Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
Am J Epidemiol. 2019 Jul 1;188(7):1213-1223. doi: 10.1093/aje/kwz048.
Our objective was to compare sex-specific rates of death with Alzheimer disease (AD) or dementia as the underlying or associated cause of death using death records. Deidentified individual records on causes of death for all people aged 60 years or more who died in Australia during 2006-2014 (n = 1,104,684) were analyzed. There were 184,562 records with International Classification of Diseases, Tenth Revision, codes for dementia (AD, vascular dementia, or unspecified dementia). Death rate ratios for women versus men were estimated using Poisson regression. Women had a greater crude rate of death from all types of dementia than men (5.9 deaths per 1,000 person-years as compared with 3.8 deaths per 1,000 person-years), which disappeared after adjustment for age. For AD, the age-adjusted rate was higher among women (rate ratio = 1.14, 95% confidence interval: 1.12, 1.16), while for vascular dementia age-adjusted rates were higher for men (rate ratio = 0.80, 95% confidence interval: 0.78, 0.82). There was no evidence of a differential bias in coding of dementia type between men and women. Women's older age at death explained much of the sex-related difference in rates of death from AD or dementia. However, excess numbers of AD deaths among women and vascular dementia deaths among men remained, providing support for the hypothesis of greater biological risk of AD in women.
我们的目的是通过死亡记录比较特定性别因阿尔茨海默病（AD）或痴呆作为根本或相关死因的死亡率。对 2006-2014 年期间在澳大利亚死亡的所有 60 岁及以上人群（n = 1,104,684）的死因进行了去识别个体记录分析。有 184,562 例记录了国际疾病分类，第十版，痴呆症（AD、血管性痴呆或未特指的痴呆）的代码。使用泊松回归估计女性与男性之间的死亡率比值。女性死于所有类型痴呆的粗死亡率高于男性（每 1,000 人年 5.9 例死亡，而每 1,000 人年 3.8 例死亡），这一差异在调整年龄后消失。对于 AD，女性的年龄调整率较高（调整后比率=1.14，95%置信区间：1.12，1.16），而血管性痴呆的年龄调整率则较高男性（调整后比率=0.80，95%置信区间：0.78，0.82）。没有证据表明性别之间在痴呆类型编码方面存在差异偏差。女性死亡时年龄较大，这在很大程度上解释了 AD 或痴呆死亡率性别差异的原因。然而，女性 AD 死亡人数和男性血管性痴呆死亡人数仍存在过多，这为女性 AD 的生物学风险更大的假设提供了支持。
