Department of Health and Care, Statistics Netherlands, The Hague, The Netherlands.
Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Int J Epidemiol. 2021 Jul 9;50(3):809-816. doi: 10.1093/ije/dyaa219.
Previous estimates of the lifetime risk of dementia are restricted to older age groups and may suffer from selection bias. In this study, we estimated the lifetime risk of dementia starting at birth using nationwide integral linked health register data.
We studied all deaths in The Netherlands in 2017 (n = 147 866). Dementia was assessed using the cause-of-death registration, individually linked with registers covering long-term care, specialized mental care, dispensed medicines, hospital discharges and claims, and primary care. The proportion of deaths with dementia was calculated for the total population and according to age at death and sex.
According to all data sources combined, 24.0% of the population dies in the presence of dementia. This proportion is higher for females (29.4%) than for males (18.3%). Using multiple causes of death only, the proportion with dementia is 17.9%. Sequential addition of long-term care and hospital discharge data increased the estimate by 4.0 and 1.5%-points, respectively. Further addition of dispensed medicines, hospital claims and specialized mental care data added another 0.6%-points. Among persons who die at age ≤65-70 years, the proportion with dementia is ≤6.2%. After age 70, the proportion rises sharply, with a peak of 43.9% for females and 33.1% for males at age 90-95 years.
Around one-fourth of the Dutch population is diagnosed with dementia at some point in life and dies in the presence of dementia. It is a major challenge to arrange optimal care for this group.
先前对痴呆症终生风险的估计仅限于老年人群体，并且可能存在选择偏倚。在这项研究中，我们使用全国性综合链接健康登记数据，从出生开始估计痴呆症的终生风险。
我们研究了 2017 年荷兰所有的死亡病例（n=147866）。使用死因登记来评估痴呆症，并将其与涵盖长期护理、专门精神护理、配药、住院出院和索赔以及初级保健的登记进行个体链接。根据总人口以及死亡时的年龄和性别计算患有痴呆症的死亡比例。
根据所有数据源的综合结果，24.0%的人口患有痴呆症而死亡。女性（29.4%）的这一比例高于男性（18.3%）。仅使用多种死因时，患有痴呆症的比例为 17.9%。连续添加长期护理和住院出院数据分别使估计值增加了 4.0 和 1.5%。进一步添加配药、住院索赔和专门精神护理数据，又增加了 0.6%。在年龄≤65-70 岁的死亡人群中，患有痴呆症的比例≤6.2%。70 岁以后，这一比例急剧上升，女性在 90-95 岁时达到峰值，为 43.9%，男性为 33.1%。
大约四分之一的荷兰人口在一生中的某个时候被诊断出患有痴呆症，并死于痴呆症。为这一人群提供最佳护理是一个重大挑战。
