Kornblith Erica, Peltz Carrie B, Xia Feng, Plassman Brenda, Novakovic-Apopain Tatjana, Yaffe Kristine
From the San Francisco Veterans Affairs Health Care System (E.K., C.B.P., F.X., T.N.-A., K.Y.); Department of Neurology (B.P.), Duke University, Durham, NC; and Departments of Psychiatry (E.K., T.N.-A., K.Y.), Neurology (K.Y.), and Epidemiology and Biostatistics (K.Y.), University of California San Francisco.
Neurology. 2020 Sep 29;95(13):e1768-e1775. doi: 10.1212/WNL.0000000000010617. Epub 2020 Sep 4.
To investigate whether sex and race differences exist in dementia diagnosis risk associated with traumatic brain injury (TBI) among older veterans.
Using Fine-Gray regression models, we investigated incident dementia diagnosis risk with TBI exposure by sex and race.
After the exclusion of baseline prevalent dementia, the final sample (all veterans ≥55 years of age diagnosed with TBI during the 2001-2015 study period and a random sample of all veterans receiving Veterans Health Administration care) included nearly 1 million veterans (4.3% female; 81.8% White, 11.5% Black, and 1.25% Hispanic), 96,178 with TBI and 903,462 without TBI. Compared to those without TBI, Hispanic veterans with TBI were almost 2 times more likely (17.0% vs 10.3%; hazard ratio [HR] 1.74, 95% confidence interval [CI] 1.51-2.01), Black veterans with TBI were >2 times more likely (11.2% vs 6.4%; HR 2.15, 95% CI 2.02-2.30), and White veterans with TBI were nearly 3 times more likely to receive a dementia diagnosis (12.0% vs 5.9%; HR 2.71, 95% CI 2.64-2.77). A significant interaction between TBI and race for dementia diagnosis was observed ( < 0.001). Both male and female veterans with TBI were more than twice as likely (men 11.8% vs 5.9%, HR 2.60, 95% CI 2.54-2.66; women 6.3% vs 3.1%, HR 2.36, 95% CI 2.08-2.69) to receive a diagnosis of dementia compared to those without. There was a significant interaction effect between sex and TBI ( = 0.02), but the magnitude of differences was small.
In this large, nationwide cohort of older veterans, all race groups with TBI had increased risk of dementia diagnosis, but there was an interaction effect such that White veterans were at greatest risk for dementia after TBI. Further research is needed to understand the mechanisms for this discrepancy. Differences in dementia diagnosis risk for men and women after TBI were significant but small, and male and female veterans had similarly high risks of dementia diagnosis after TBI.
探讨老年退伍军人中与创伤性脑损伤（TBI）相关的痴呆症诊断风险是否存在性别和种族差异。
使用Fine-Gray回归模型，我们按性别和种族调查了TBI暴露情况下的痴呆症诊断风险。
排除基线时的现患痴呆症后，最终样本（所有在2001年至2015年研究期间年龄≥55岁且被诊断为TBI的退伍军人以及接受退伍军人健康管理局护理的所有退伍军人的随机样本）包括近100万退伍军人（4.3%为女性；81.8%为白人，11.5%为黑人，1.25%为西班牙裔），96178例有TBI，903462例无TBI。与无TBI的退伍军人相比，有TBI的西班牙裔退伍军人被诊断为痴呆症的可能性几乎高出2倍（17.0%对10.3%；风险比[HR]1.74，95%置信区间[CI]1.51 - 2.01），有TBI的黑人退伍军人高出2倍多（11.2%对6.4%；HR 2.15，95% CI 2.02 - 2.30），有TBI的白人退伍军人被诊断为痴呆症的可能性几乎高出3倍（12.0%对5.9%；HR 2.71，95% CI 2.64 - 2.77）。观察到TBI与种族在痴呆症诊断方面存在显著交互作用（<0.001）。与无TBI的退伍军人相比，有TBI的男性和女性退伍军人被诊断为痴呆症的可能性均高出两倍多（男性11.8%对5.9%，HR 2.60，95% CI 2.54 - 2.66；女性6.3%对3.1%，HR 2.36，95% CI 2.08 - 2.69）。性别与TBI之间存在显著交互作用（=0.02），但差异幅度较小。
在这个全国性的老年退伍军人大型队列中，所有有TBI的种族群体痴呆症诊断风险均增加，但存在交互作用，使得白人退伍军人在TBI后患痴呆症的风险最高。需要进一步研究以了解这种差异的机制。TBI后男性和女性痴呆症诊断风险的差异显著但较小，男性和女性退伍军人在TBI后痴呆症诊断风险同样高。
