Department of Internal Medicine, Division of Infectious Diseases, Allergy, and Immunology, Saint Louis University, School of Medicine, Saint Louis, Missouri, USA.
The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University, School of Medicine, St. Louis, Missouri, USA.
J Am Geriatr Soc. 2022 Apr;70(4):1157-1168. doi: 10.1111/jgs.17606. Epub 2021 Dec 12.
Multiple types of vaccinations are associated with lower risk for dementia, but it is not known if receiving more than one vaccination type is associated with a greater decrease in incident dementia as compared with receiving only one type. We determined if dementia risk is lowest in patients who receive both herpes zoster (HZ) and tetanus, diphtheria, pertussis (Tdap) vaccinations as compared with receipt of only one or the other type of vaccination.
Primary analysis in a Veterans Health Administration (VA) cohort was replicated in private sector medical claims data. Eligible patients were ≥65 years of age and free of dementia for 2 years prior to baseline (VHA n = 80,070; MarketScan n = 129,200). At index, patients either had both HZ and Tdap, only HZ, only Tdap, or neither vaccination. Confounding was controlled with generalized boosted propensity scores and inverse probability of treatment weighting. Competing risk (VHA) and Cox proportional hazard (MarketScan) models estimated the association between vaccination status and incident dementia.
VHA patients' mean age was 76.8 ± 7.6 years, 4.4% were female and 90.9% were White, and MarketScan patients' mean age was 70.5 ± 5.9 and 65.4% were female. In both cohorts, having both HZ and Tdap vaccinations compared with no vaccination was significantly associated with lower dementia risk (VHA HR = 0.50; 95% CI: 0.43-0.59; MarketScan HR = 0.58; 95% CI: 0.38-0.89). In both cohorts, compared with neither vaccination, patients with only one or the other vaccination types had a significantly lower risk for dementia. Incident dementia was lower in patients with both vaccinations versus only one vaccination type.
Receiving two types of vaccinations versus one type was associated with lower dementia risk. Vaccinations may have non-specific associations with incident dementia. Low cost and accessible, common adult vaccinations may be an overlooked intervention for reducing dementia risk.
多种类型的疫苗接种与痴呆风险降低相关，但尚不清楚与接种一种疫苗相比，接种多种疫苗是否与痴呆发病率的降低幅度更大有关。我们确定与仅接种一种疫苗相比，接种带状疱疹 (HZ) 和破伤风、白喉、百日咳 (Tdap) 疫苗的患者痴呆风险是否最低。
在退伍军人健康管理局 (VA) 队列中的主要分析在私营部门医疗索赔数据中得到了复制。合格患者年龄≥65 岁，且在基线前 2 年内无痴呆（VA 组 n=80070；MarketScan 组 n=129200）。在指数时，患者要么同时接种了 HZ 和 Tdap，要么仅接种了 HZ，要么仅接种了 Tdap，要么两种疫苗都未接种。混杂因素通过广义增强倾向评分和治疗反概率加权进行控制。竞争风险（VA）和 Cox 比例风险（MarketScan）模型估计了接种状态与新发痴呆之间的关联。
VA 患者的平均年龄为 76.8±7.6 岁，4.4%为女性，90.9%为白人，MarketScan 患者的平均年龄为 70.5±5.9 岁，65.4%为女性。在两个队列中，与未接种疫苗相比，同时接种 HZ 和 Tdap 疫苗与痴呆风险显著降低相关（VA HR=0.50；95%CI：0.43-0.59；MarketScan HR=0.58；95%CI：0.38-0.89）。在两个队列中，与未接种疫苗相比，接种一种或另一种疫苗类型的患者痴呆风险显著降低。与仅接种一种疫苗相比，同时接种两种疫苗的患者痴呆发病率更低。
与接种一种疫苗相比，接种两种疫苗与痴呆风险降低相关。疫苗接种可能与痴呆的发生存在非特异性关联。低成本、易于获得的常见成人疫苗可能是一种被忽视的降低痴呆风险的干预措施。
