Booth Michael J, Janevic Mary R, Kobayashi Lindsay C, Clauw Daniel J, Piette John D
Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48130, USA.
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
BMC Rheumatol. 2021 Aug 18;5(1):24. doi: 10.1186/s41927-021-00198-z.
Studies suggest an increased prevalence of cognitive impairment (CI) among people with rheumatoid arthritis (RA). However, most prior studies have used convenience samples which are subject to selection biases or have failed to adjust for key confounding variables. We thus examined the association between CI and RA in a large national probability sample of older US adults.
Data were from interviews with 4462 participants in the 2016 wave of the nationally representative U.S. Health and Retirement Study with linked Medicare claims. RA diagnoses were identified via a minimum of two ICD-9CM or ICD-10 codes in Medicare billing records during the prior 2 years. The Langa-Weir Classification was used to classify cognitive status as normal, cognitively impaired non-dementia (CIND), or dementia based on a brief neuropsychological battery for self-respondents and informant reports for proxy respondents. We compared the odds of CI between older adults with and without RA using logistic regression, adjusted for age, education, gender, and race.
Medicare records identified a 3.36% prevalence of RA (150/4462). While age, gender, education, and race independently predicted CI status, controlling for these covariates we found no difference in CI prevalence according to RA status (prevalent CI in 36.7% of older adults with RA vs. 34.0% without RA; adjusted OR = 1.08, 95% CI 0.74-1.59, p = .69).
There was no association between RA and CI in this national sample of older U.S. adults.
研究表明类风湿关节炎（RA）患者中认知障碍（CI）的患病率有所增加。然而，大多数先前的研究使用的是便利样本，容易受到选择偏倚的影响，或者未能对关键的混杂变量进行调整。因此，我们在美国老年成年人的大型全国概率样本中研究了CI与RA之间的关联。
数据来自对2016年全国代表性的美国健康与退休研究中4462名参与者的访谈，这些访谈与医疗保险理赔记录相关联。通过在过去2年的医疗保险计费记录中至少两个ICD-9CM或ICD-10代码来确定RA诊断。基于自我受访者的简短神经心理测试和代理受访者的信息报告，使用兰加-韦尔分类法将认知状态分为正常、非痴呆性认知障碍（CIND）或痴呆。我们使用逻辑回归比较了有和没有RA的老年人中CI的几率，并对年龄、教育程度、性别和种族进行了调整。
医疗保险记录显示RA的患病率为3.36%（150/4462）。虽然年龄、性别、教育程度和种族独立预测CI状态，但在控制这些协变量后，我们发现根据RA状态，CI患病率没有差异（患有RA的老年人中CI患病率为36.7%，无RA的老年人中为34.0%；调整后的OR = 1.08，95% CI 0.74 - 1.59，p = 0.69）。
在这个美国老年成年人的全国样本中，RA与CI之间没有关联。
