Justin T McDaniel, Southern Illinois University Carbondale, USA,
J Prev Alzheimers Dis. 2021;8(4):457-461. doi: 10.14283/jpad.2021.28.
Although studies have examined the geographic distribution of dementia among the general population in order to develop geographically targeted interventions, no studies have examined the geographic distribution of subjective cognitive decline (SCD) among military veterans specifically.
To map the geographic distribution of subjective cognitive decline from 2011-2019 in the United States among military veterans.
Cross-sectional.
United States.
Individuals reporting previous service in the United States Armed Forces.
Using 2011 Behavioral Risk Factor Surveillance System (BRFSS) data, which is last year for which geocoded SCD data is publicly available, we estimated the survey-weighted county-level prevalence of veteran SCD for counties with >30 veterans (43 counties in 7 states). We then developed a Fay-Herriot small area estimation linear model using auxiliary data from the Census, with county-level veteran-specific covariates including % >65 years old, % female, % college educated, and median income. Following model validation, we created beta-weighted predictions of veteran SCD for all USA counties for 2011-2019 using relevant time-specific Census auxiliary data. We provide choropleth maps of our predictions.
Results of our model on 43 counties showed that county-level rates of SCD were significantly associated with all auxiliary variables except annual income (F = 1.49, df = 4, 38). Direct survey-weighted rates were correlated with model-predicted rates in 43 counties (Pearson r = 0.32). Regarding predicted rates for the entire USA, the average county-level prevalence rate of veteran SCD in 2011 was 13.83% (SD = 7.35), but 29.13% in 2019 (SD = 14.71) - although variation in these rates were evident across counties.
SCD has increased since 2011 among veterans. Veterans Affairs hospitals should implement plans that include cognitive assessments, referral to resources, and monitoring patient progress, especially in rural areas.
尽管已有研究调查了一般人群中痴呆症的地理分布情况，以便制定具有针对性的地理干预措施，但尚无研究专门调查退伍军人中主观认知下降（SCD）的地理分布情况。
绘制美国退伍军人中 2011 年至 2019 年主观认知下降的地理分布图谱。
横断面研究。
美国。
报告曾在美国武装部队服役的个人。
利用 2011 年行为风险因素监测系统（BRFSS）数据（这是公开提供 SCD 地理编码数据的最后一年），我们根据退伍军人数量>30 的县估计了 BRFSS 数据中退伍军人 SCD 的调查加权县患病率（美国 7 个州的 43 个县）。然后，我们使用人口普查的辅助数据，使用包含>65 岁、女性、受过大学教育和中等收入的退伍军人特定县一级的协变量，开发了费-赫里奥特小区域估计线性模型。在模型验证之后，我们使用相关的特定年份人口普查辅助数据，为 2011 年至 2019 年的美国所有县创建了退伍军人 SCD 的β加权预测值。我们提供了预测值的专题地图。
我们对 43 个县的模型结果表明，县一级的 SCD 发生率与所有辅助变量显著相关，除了年收入（F = 1.49，df = 4，38）。直接调查加权率与 43 个县的模型预测率相关（Pearson r = 0.32）。关于美国整个地区的预测率，2011 年退伍军人 SCD 的平均县一级患病率为 13.83%（SD = 7.35），但 2019 年为 29.13%（SD = 14.71）-尽管这些比率在县之间存在明显差异。
自 2011 年以来，退伍军人的 SCD 有所增加。退伍军人事务部医院应实施包括认知评估、向资源转介和监测患者进展的计划，特别是在农村地区。
