Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA.
School of Nursing and Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA.
J Am Geriatr Soc. 2021 Mar;69(3):629-636. doi: 10.1111/jgs.16908. Epub 2020 Nov 12.
BACKGROUND/OBJECTIVES: Given the lack of effective pharmacologic strategies to prevent, slow, or reverse dementia progression, maximizing quality of life (QOL) is a major priority for persons living with dementia. Despite well-documented racial/ethnic disparities in dementia incidence and prevalence, it is unknown whether there are racial/ethnic disparities in QOL among persons with dementia. The objective of this study was to determine if there are racial/ethnic differences in poor health-related quality of life (HRQOL) among persons with and without dementia in a nationally-representative cohort.
Repeated measures cross-sectional analysis of a prospective cohort study.
United States nationally-representative National Health and Aging Trends Study (2011-2018).
Non-nursing home-dwelling Black, Latino, and white adults age 65+ (n = 10,886).
We estimated racial/ethnic differences in five dichotomous indicators of poor HRQOL (depressive and anxiety symptoms, self-rated health, pain, and physical functional limitations), stratified by dementia status (probable, possible, none). We used generalized estimating equations to estimate prevalence ratios (PRs) and differences, and marginal standardization to estimate prevalence.
Generally, Blacks and Latinos reported higher prevalence of poor HRQOL compared with whites. The largest differences were observed for self-rated health, and Latino-white differences were slightly larger compared to Black-white differences. PRs were larger among those with no dementia. For example, the Black versus white PRs for poor self-rated health were 1.93 (95% confidence interval (CI) = 1.82-2.04) among the no dementia group and 1.21 (95% CI = 1.12-1.31) among the probable dementia group; Latino versus white PRs for these comparisons were 2.39 (2.21-2.59) and 1.48 (1.35-1.62), respectively. Prevalence differences also showed racial/ethnic differences, but these were similar across dementia statuses.
We observed racial/ethnic disparities in poor HRQOL, showing greater unmet clinical needs among Black and Latino versus white older adults. Relative disparities were smaller in those with dementia, but absolute magnitudes of disparities were similar by dementia status.
背景/目的：鉴于目前缺乏有效的药物策略来预防、延缓或逆转痴呆症的进展，最大限度地提高生活质量（QOL）是痴呆症患者的主要优先事项。尽管痴呆症的发病率和患病率存在有据可查的种族/民族差异，但尚不清楚痴呆症患者的 QOL 是否存在种族/民族差异。本研究的目的是确定在一个具有全国代表性的队列中，是否存在痴呆症患者和非痴呆症患者的健康相关生活质量（HRQOL）不良的种族/民族差异。
对一项前瞻性队列研究的重复测量横断面分析。
美国具有全国代表性的国家健康老龄化趋势研究（2011-2018 年）。
非养老院居住的 65 岁及以上的黑种人、拉丁裔和白种成年人（n=10886）。
我们根据痴呆症的状况（可能、可能、无），估计了五个二分法不良 HRQOL 指标（抑郁和焦虑症状、自我报告的健康状况、疼痛和身体功能障碍）的种族/民族差异。我们使用广义估计方程来估计患病率比值（PRs）和差异，并使用边缘标准化来估计患病率。
一般来说，黑人和拉丁裔人报告的不良 HRQOL 患病率高于白人。最大的差异出现在自我报告的健康状况上，拉丁裔人与白人的差异略大于黑人和白人的差异。在没有痴呆症的人群中，PR 更大。例如，在没有痴呆症的人群中，黑人和白人不良自我报告健康状况的 PR 为 1.93（95%置信区间（CI）=1.82-2.04），而在可能患有痴呆症的人群中，这一比例为 1.21（95%CI=1.12-1.31）；对于这些比较，拉丁裔人与白人的 PR 分别为 2.39（2.21-2.59）和 1.48（1.35-1.62）。患病率差异也显示出种族/民族差异，但在痴呆症状况方面差异相似。
我们观察到在不良 HRQOL 方面存在种族/民族差异，表明黑人和拉丁裔老年人的临床需求未得到满足的情况更为严重。在痴呆症患者中，相对差异较小，但根据痴呆症状况，差异的绝对值相似。
