College of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
BMC Geriatr. 2022 Jan 10;22(1):39. doi: 10.1186/s12877-021-02740-7.
The aim of the study was to examine the explanatory role of sociodemographic, clinical, behavioral, and social factors on racial/ethnic differences in cognitive decline among adults with diabetes.
Adults aged 50+ years with diabetes from the Health and Retirement Survey were assessed for cognitive function (normal, mild cognitive impairment [MCI], and dementia). Generalized estimating equation (GEE) logistic regression models were used to account for repeating measures over time. Models were adjusted for sociodemographic (gender, age, education, household income and assets), behavioral (smoking), clinical (ie. comorbidities, body mass index), and social (social support, loneliness, social participation, perceived constraints and perceived mastery on personal control) factors.
Unadjusted models showed non-Hispanic Blacks (NHB) and Hispanics were significantly more likely to progress from normal cognition to dementia (NHB OR: 2.99, 95%CI 2.35-3.81; Hispanic OR: 3.55, 95%CI 2.77-4.56), and normal cognition to MCI (NHB OR = 2.45, 95%CI 2.14-2.82; Hispanic OR = 2.49, 95%CI 2.13-2.90) compared to non-Hispanic Whites (NHW). Unadjusted models for the transition from mild cognitive decline to dementia showed Hispanics were more likely than NHW to progress (OR = 1.43, 95%CI 1.11-1.84). After adjusting for sociodemographic, clinical/behavioral, and social measures, NHB were 3.75 times more likely (95%CI 2.52-5.56) than NHW to reach dementia from normal cognition. NHB were 2.87 times more likely (95%CI 2.37-3.48) than NHW to reach MCI from normal. Hispanics were 1.72 times more likely (95%CI 1.17-2.52) than NHW to reach dementia from MCI.
Clinical/behavioral and social factors did not explain racial/ethnic disparities. Racial/ethnic disparities are less evident from MCI to dementia, emphasizing preventative measures/interventions before cognitive impairment onset are important.
本研究旨在探讨社会人口学、临床、行为和社会因素对伴有糖尿病的成年人认知能力下降的种族/民族差异的解释作用。
来自健康与退休调查的年龄在 50 岁及以上、患有糖尿病的成年人接受了认知功能（正常、轻度认知障碍[MCI]和痴呆）评估。采用广义估计方程（GEE）逻辑回归模型来解释随时间重复测量的情况。模型调整了社会人口学（性别、年龄、教育、家庭收入和资产）、行为（吸烟）、临床（合并症、体重指数）和社会因素（社会支持、孤独感、社会参与、感知个人控制的限制和掌握程度）。
未调整模型显示，非西班牙裔黑人（NHB）和西班牙裔人从正常认知进展为痴呆的可能性明显更高（NHB OR：2.99，95%CI 2.35-3.81；西班牙裔 OR：3.55，95%CI 2.77-4.56），从正常认知进展为轻度认知障碍的可能性也更高（NHB OR=2.45，95%CI 2.14-2.82；西班牙裔 OR=2.49，95%CI 2.13-2.90），而非西班牙裔白人（NHW）。未调整的从轻度认知障碍进展为痴呆的模型显示，西班牙裔人比 NHW 更有可能进展（OR=1.43，95%CI 1.11-1.84）。在调整社会人口学、临床/行为和社会措施后，NHB 从正常认知进展为痴呆的可能性是 NHW 的 3.75 倍（95%CI 2.52-5.56）。NHB 从正常认知进展为 MCI 的可能性是 NHW 的 2.87 倍（95%CI 2.37-3.48）。西班牙裔人从 MCI 进展为痴呆的可能性是 NHW 的 1.72 倍（95%CI 1.17-2.52）。
临床/行为和社会因素并不能解释种族/民族差异。从 MCI 到痴呆，种族/民族差异不太明显，这强调了在认知障碍出现之前采取预防措施/干预措施的重要性。
