Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
School of Nursing, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
JAMA Netw Open. 2022 May 2;5(5):e2210474. doi: 10.1001/jamanetworkopen.2022.10474.
Several studies have suggested that older-onset dementia is associated with an increased risk of motor vehicle crash injury (MVCI). However, evidence of an association between young-onset dementia and the risk of MVCI is insufficient, particularly in Asia.
To investigate the association between young-onset dementia and MVCI-related hospitalization in Taiwan.
DESIGN, SETTING, AND PARTICIPANTS: In this nationwide, population-based cohort study in Taiwan, a cohort of 39 344 patients aged 40 to 64 years with incident dementia diagnosed between 2006 and 2012 was matched 1:1 with a cohort of participants without dementia by age, sex, and index year (initial diagnosis of dementia). Participants were identified from Taiwan's National Health Insurance Research Database (NHIRD). Data were analyzed between March 25 and October 22, 2021.
Dementia, defined by International Classification of Diseases, Ninth Revision, Clinical Modification codes.
Hospitalization for MVCI, determined using linked data from Taiwan's Police-Reported Traffic Accident Registry and the NHIRD from January 1, 2003, to December 31, 2015. Hazard ratios (HRs) for MVCI-related hospitalization were estimated using Cox proportional hazards regression models adjusted for sex, age, salary-based insurance premium, urbanization level, and comorbidities.
Of the 78 688 participants, 47 034 (59.8%) were male; the mean (SD) age was 54.5 (7.4) years. During the 10-year follow-up period, the incidence density of MVCI-related hospitalization was 45.58 per 10 000 person-years (95% CI, 42.77-48.39 per 10 000 person-years) among participants with dementia and 24.10 per 10 000 person-years (95% CI, 22.22-25.99 per 10 000 person-years) among participants without dementia. Compared with participants without dementia, patients with young-onset dementia were at higher risk of MVCI-related hospitalization (adjusted HR [aHR], 1.83; 95% CI, 1.63-2.06), especially those in younger age groups (aged 40-44 years: aHR, 3.54; 95% CI, 2.48-5.07) and within a shorter period (within 1 year of follow-up: aHR, 3.53; 95% CI, 2.50-4.98) after dementia was diagnosed. Patients with young-onset dementia also had a higher risk of being a pedestrian when the crash occurred (aHR, 2.89; 95% CI, 2.04-4.11), having an intracranial or internal injury (aHR, 2.44; 95% CI, 2.02-2.94), and having a severe injury (aHR, 2.90; 95% CI, 2.16-3.89).
In this retrospective cohort study, patients in Taiwan with a diagnosis of young-onset dementia had a higher risk of MVCI-related hospitalization than did individuals without dementia and the risk varied by age, disease duration, transport mode, injury type, and injury severity. These findings suggest a need for the planning of strategies to prevent transportation crashes among patients with young-onset dementia.
几项研究表明，老年发病痴呆与机动车事故伤害（MVCI）的风险增加有关。然而，年轻人发病痴呆与 MVCI 风险之间的关联证据不足，特别是在亚洲。
调查台湾年轻人发病痴呆与 MVCI 相关住院的关联。
设计、地点和参与者：在台湾进行的这项全国性、基于人群的队列研究中，从台湾全民健康保险研究数据库（NHIRD）中确定了 2006 年至 2012 年间确诊的 39344 名年龄在 40 至 64 岁之间的患有痴呆症的患者的队列，并按年龄、性别和指数年（初始痴呆症诊断）与没有痴呆症的患者进行 1:1 匹配。参与者在年龄 40-44 岁和随访 1 年内被诊断出患有痴呆症的患者中风险最高（HR，分别为 3.54 和 3.53）。患有年轻发病痴呆症的患者发生 MVCI 的风险也更高，尤其是在年轻年龄组（发生 HR，2.89；95%CI，2.04-4.11）和在诊断后较短的时间内（发生 HR，2.44；95%CI，2.02-2.94）。
在这项回顾性队列研究中，台湾患有年轻发病痴呆症的患者发生 MVCI 相关住院的风险高于没有痴呆症的患者，且风险因年龄、疾病持续时间、交通方式、损伤类型和损伤严重程度而异。这些发现表明需要制定策略来预防年轻发病痴呆症患者的交通碰撞。
