Kaiser Permanente Division of Research, Oakland.
University of California Los Angeles Fielding School of Public Health, Los Angeles.
Alzheimer Dis Assoc Disord. 2019 Jul-Sep;33(3):200-205. doi: 10.1097/WAD.0000000000000313.
Posttraumatic stress disorder is associated with increased dementia risk but less is known about stress because of everyday problems in diverse populations.
A total of 9605 health care plan members who provided information regarding midlife stressors in 1972 to 1973 (ages, 40 to 55 y) were followed for dementia diagnosis between 1996 and 2017. Cox proportional hazard models evaluated associations between midlife stressors and dementia adjusting for demographics and lifecourse health indicators.
Reporting at least 1 midlife stressor was associated with 17% greater dementia risk [hazard ratio (HR), 1.17; 95% confidence interval (CI),1.07-1.27] versus 0 midlife stressors and 26% increased risk among those with less than equal to high school education (HR, 1.26; 95% CI,1.09-1.44) adjusting for demographics. Compared with whites without stressors, whites with ≥1 stressor had 13% greater dementia risk (HR, 1.13; 95% CI, 1.02-1.24), blacks without stressors 19% greater risk (HR, 1.19; 95% CI,1.08-1.32), and blacks with ≥1 stressors 47% greater risk (HR, 1.47; 95% CI,1.27-1.69) in fully adjusted models. Resource problems were associated with 20% greater risk (HR, 1.20; 95% CI, 1.01-1.42) than interpersonal problems.
Reporting ≥1 serious midlife stressor was associated with elevated dementia risk, especially stressors related to resources problems and for those with less than equal to high school education. Everyday stressors can impact brain health over the long term and may contribute to racial inequities in dementia rates, though education can be a mitigating factor.
创伤后应激障碍与痴呆风险增加有关，但由于不同人群日常生活中的问题，对于压力的了解较少。
共有 9605 名医疗保健计划成员于 1972 年至 1973 年（年龄 40 至 55 岁）提供了中年压力源信息，他们在 1996 年至 2017 年间被跟踪诊断为痴呆症。Cox 比例风险模型评估了中年压力源与痴呆症之间的关联，同时调整了人口统计学和生命历程健康指标。
与没有中年压力源的参与者相比，报告至少有 1 个中年压力源的参与者痴呆风险增加了 17%（风险比 [HR]，1.17；95%置信区间 [CI]，1.07-1.27），而受教育程度低于或等于高中学历的参与者风险增加了 26%（HR，1.26；95% CI，1.09-1.44）。与没有压力源的白人相比，有≥1 个压力源的白人痴呆风险增加了 13%（HR，1.13；95% CI，1.02-1.24），没有压力源的黑人痴呆风险增加了 19%（HR，1.19；95% CI，1.08-1.32），而有≥1 个压力源的黑人痴呆风险增加了 47%（HR，1.47；95% CI，1.27-1.69）。在完全调整的模型中，资源问题与 20%的更高风险相关（HR，1.20；95% CI，1.01-1.42），而人际关系问题则与之相关。
报告≥1 个严重的中年压力源与痴呆风险增加相关，尤其是与资源问题相关的压力源，以及受教育程度低于或等于高中学历的参与者。日常生活中的压力源可能会长期影响大脑健康，并可能导致痴呆症发病率的种族差异，尽管教育可能是一个缓解因素。
