Santé publique France, Saint-Maurice, France.
Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Inserm, Villejuif, France.
PLoS Med. 2021 Sep 23;18(9):e1003801. doi: 10.1371/journal.pmed.1003801. eCollection 2021 Sep.
Dementia onset in those aged <65 years (young onset dementia, YOD) has dramatic individual and societal consequences. In the context of population aging, data on YOD are of major importance to anticipate needs for planning and allocation of health and social resources. Few studies have provided precise frequency estimates of YOD. The aim of this study is to provide YOD prevalence and incidence estimates in France and to study the contribution of comorbidities to YOD incidence.
Using data from the French national health data system (Système National des Données de Santé, SNDS) for 76% of the French population aged 40 to 64 years in 2016 (n = 16,665,795), we identified all persons with dementia based on at least 1 of 3 criteria: anti-Alzheimer drugs claims, hospitalization with the International Classification of Diseases-10th Revision (ICD-10) dementia codes (F00 to F03, G30, G31.0, G31.1, or F05.1), or registration for free healthcare for dementia. We estimated prevalence rate (PR) and incidence rate (IR) and estimated the association of comorbidities with incident YOD. Sex differences were investigated. We identified 18,466 (PRstandardized = 109.7/100,000) and 4,074 incident (IRstandardized = 24.4/100,000 person-years) persons with prevalent and incident YOD, respectively. PR and IR sharply increased with age. Age-adjusted PR and IR were 33% (95% confidence interval (CI) = 29 to 37) and 39% (95% CI = 31 to 48) higher in men than women (p < 0.001 both for PR and IR). Cardio- and cerebrovascular, neurological, psychiatric diseases, and traumatic brain injury prevalence were associated with incident YOD (age- and sex-adjusted p-values <0.001 for all comorbidities examined, except p = 0.109 for antihypertensive drug therapy). Adjustment for all comorbidities explained more than 55% of the sex difference in YOD incidence. The lack of information regarding dementia subtypes is the main limitation of this study.
We estimated that there were approximately 24,000 and approximately 5,300 persons with prevalent and incident YOD, respectively, in France in 2016. The higher YOD frequency in men may be partly explained by higher prevalence of cardiovascular and neurovascular diseases, substance abuse disorders, and traumatic brain injury and warrants further investigation.
<65 岁（早发性痴呆，YOD）的痴呆发病具有显著的个体和社会后果。在人口老龄化的背景下，YOD 的数据对于规划和分配卫生和社会资源的需求具有重要意义。很少有研究提供 YOD 发病频率的精确估计。本研究的目的是提供法国 YOD 的患病率和发病率估计，并研究合并症对 YOD 发病率的贡献。
使用法国国家健康数据系统（Système National des Données de Santé，SNDS）的数据，我们对 2016 年年龄在 40 至 64 岁之间的 76%的法国人口（n=16,665,795）进行了分析，根据至少 1 项标准确定了所有患有痴呆症的患者：抗阿尔茨海默病药物的使用、国际疾病分类第 10 版（ICD-10）痴呆症代码（F00 至 F03、G30、G31.0、G31.1 或 F05.1）的住院治疗，或免费的痴呆症医疗保健注册。我们估计了患病率（PR）和发病率（IR），并估计了合并症与 YOD 发病的关联。研究了性别差异。我们分别确定了 18,466 例（标准化 PR=109.7/100,000）和 4,074 例（标准化 IR=24.4/100,000 人年）的现有和新发 YOD 患者。PR 和 IR 随着年龄的增长而急剧增加。与女性相比，男性的年龄调整后的 PR 和 IR 分别高 33%（95%置信区间（CI）=29 至 37）和 39%（95% CI = 31 至 48）（p<0.001 均适用于 PR 和 IR）。心血管和脑血管、神经、精神疾病以及创伤性脑损伤的患病率与新发 YOD 相关（除抗高血压药物治疗的 p 值为 0.109 外，所有检查的合并症的年龄和性别调整后 p 值均<0.001）。对所有合并症的调整解释了 YOD 发病率性别差异的 55%以上。本研究的主要局限性是缺乏关于痴呆症亚型的信息。
我们估计，2016 年法国大约有 24,000 人和大约 5,300 人患有现有和新发 YOD。男性 YOD 发病率较高可能部分归因于心血管和神经血管疾病、物质滥用障碍和创伤性脑损伤的患病率较高，需要进一步研究。
