Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California.
Am J Epidemiol. 2019 Jul 1;188(7):1224-1227. doi: 10.1093/aje/kwz047.
The majority of people living with Alzheimer disease (AD) and related dementias are women. Longer life expectancy is one factor thought to contribute to this observation, but possible sex-specific biological mechanisms have received considerable attention from the research community. In the current issue of the Journal, Buckley et al. (Am J Epidemiol. 2019;188(7):1213-1223) use death certificate information on all deaths occurring among adults aged ≥60 years in Australia between 2006 and 2014 to evaluate sex/gender differences in rates of death with dementia (all types), AD dementia, and vascular dementia listed on the death certificate. The paper by Buckley et al. highlights several important methodological challenges for research examining sex/gender differences in risk of AD and related dementias, including challenges in measurement, survival bias and competing risks, and selection bias arising from sample selection. The current evidence on possible sex-specific biological risk factors for AD is intriguing, but there are numerous alternative explanations for differences in AD dementia and AD biomarkers between women and men. Triangulation of evidence from study designs with different strengths and weaknesses and transdisciplinary collaboration will be vital to generating conclusive evidence about sex/gender differences in risk of AD and related dementias.
大多数患有阿尔茨海默病（AD）和相关痴呆症的人是女性。预期寿命的延长被认为是造成这种观察结果的一个因素，但研究界已经对可能存在的性别特异性生物学机制给予了相当多的关注。在本期《美国流行病学杂志》上，Buckley 等人（Am J Epidemiol. 2019;188(7):1213-1223）利用澳大利亚 2006 年至 2014 年间所有 60 岁及以上成年人的死亡证明信息，评估了在死亡证明上列出的痴呆症（所有类型）、AD 痴呆症和血管性痴呆症的死亡率方面的性别差异。Buckley 等人的论文强调了研究 AD 及相关痴呆症风险中的性别差异时面临的几个重要方法学挑战，包括测量、生存偏差和竞争风险以及因样本选择而产生的选择偏差等方面的挑战。目前关于 AD 可能存在的性别特异性生物学风险因素的证据很有趣，但女性和男性之间 AD 痴呆症和 AD 生物标志物的差异有许多其他解释。来自具有不同优势和劣势的研究设计的证据的三角测量以及跨学科合作对于产生关于 AD 及相关痴呆症风险中的性别差异的确凿证据将至关重要。
