Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA,
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA,
Neuroepidemiology. 2021;55(2):100-108. doi: 10.1159/000513276. Epub 2021 Mar 3.
Despite rapid population aging, there are currently limited data on the incidence of aging-related cognitive impairment in sub-Saharan Africa. We aimed to determine the incidence of cognitive impairment and its distribution across key demographic, social, and health-related factors among older adults in rural South Africa.
Data were from in-person interviews with 3,856 adults aged ≥40 who were free from cognitive impairment at baseline in the population-representative cohort, "Health and Aging in Africa: a Longitudinal Study of an INDEPTH Community in South Africa" (HAALSI), in Agincourt sub-district, Mpumalanga province, South Africa (2014-19). Cognitive impairment was defined as scoring <1.5 standard deviations below the mean of the baseline distribution of orientation and episodic memory scores. Incidence rates and rate ratios for cognitive impairment were estimated according to key demographic, social, and health-related factors, adjusted for age, sex/gender, and country of birth.
The incidence of cognitive impairment was 25.7/1,000 person-years (PY; 95% confidence interval [CI]: 23.0-28.8), weighted for mortality (12%) and attrition (6%) over the 3.5-year mean follow-up (range: 1.5-4.8 years). Incidence increased with age, from 8.9/1,000 PY (95% CI: 5.2-16.8) among those aged 40-44 to 93.5/1,000 PY (95% CI: 75.9-116.3) among those aged 80+, and age-specific risks were similar by sex/gender. Incidence was strongly associated with formal education and literacy, as well as marital status, household assets, employment, and alcohol consumption but not with history of smoking, hypertension, stroke, angina, heart attack, diabetes, or prevalent HIV.
This study presents some of the first incidence rate estimates for aging-related cognitive impairment in rural South Africa. Social disparities in incident cognitive impairment rates were apparent in patterns similar to those observed in many high-income countries.
尽管人口迅速老龄化，但目前撒哈拉以南非洲地区与年龄相关的认知障碍发病率数据有限。我们旨在确定认知障碍的发病率及其在南非农村老年人中与关键人口统计学、社会和健康相关因素的分布情况。
数据来自于面对面访谈，受访者为 3856 名年龄在 40 岁及以上、基线时无认知障碍的人群，他们来自南非姆普马兰加省阿格因库尔特区的代表性人群队列“非洲的健康与老龄化：南非一个 INDEPTH 社区的纵向研究”（HAALSI）（2014-19 年）。认知障碍的定义为定向和情景记忆评分基线分布的平均分数低于 1.5 个标准差。根据关键人口统计学、社会和健康相关因素，对认知障碍的发生率和发生率比进行了估计，调整了年龄、性别/性别和出生国。
认知障碍的发病率为 25.7/1000 人年（95%置信区间[CI]：23.0-28.8），在 3.5 年的平均随访期间（范围：1.5-4.8 年），死亡率（12%）和流失率（6%）进行了加权。发病率随年龄增长而增加，从 40-44 岁人群的 8.9/1000 人年（95%CI：5.2-16.8）增加到 80 岁以上人群的 93.5/1000 人年（95%CI：75.9-116.3），性别/性别差异相似。发病率与正规教育和读写能力以及婚姻状况、家庭资产、就业和饮酒高度相关，但与吸烟史、高血压、中风、心绞痛、心脏病发作、糖尿病或现患艾滋病毒无关。
本研究提供了南非农村地区与年龄相关的认知障碍发病率的一些首批估计。在与许多高收入国家观察到的模式相似的情况下，认知障碍发生率的社会差异明显。
