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Hearing Loss and Dementia: A Meta-Analysis of Prospective Cohort Studies.听力损失与痴呆症:前瞻性队列研究的荟萃分析
Front Aging Neurosci. 2021 Jul 8;13:695117. doi: 10.3389/fnagi.2021.695117. eCollection 2021.
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Dementia prevention, intervention, and care: 2020 report of the Lancet Commission.《痴呆症的预防、干预与照护:柳叶刀委员会2020年报告》
Lancet. 2020 Aug 8;396(10248):413-446. doi: 10.1016/S0140-6736(20)30367-6. Epub 2020 Jul 30.
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Evidence-based prevention of Alzheimer's disease: systematic review and meta-analysis of 243 observational prospective studies and 153 randomised controlled trials.基于证据的阿尔茨海默病预防:243 项观察性前瞻性研究和 153 项随机对照试验的系统评价和荟萃分析。
J Neurol Neurosurg Psychiatry. 2020 Nov;91(11):1201-1209. doi: 10.1136/jnnp-2019-321913. Epub 2020 Jul 20.
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Validation of self-reported height and weight in a large, nationwide cohort of U.S. adults.验证美国成年人大型全国队列中自我报告的身高和体重。
PLoS One. 2020 Apr 13;15(4):e0231229. doi: 10.1371/journal.pone.0231229. eCollection 2020.
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Depressive Symptoms in the Elderly-An Early Symptom of Dementia? A Systematic Review.老年人的抑郁症状——痴呆症的早期症状?一项系统综述。
Front Pharmacol. 2020 Feb 7;11:34. doi: 10.3389/fphar.2020.00034. eCollection 2020.
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Disparities in current cigarette smoking among US adults, 2002-2016.美国成年人当前吸烟率的差异,2002-2016 年。
Tob Control. 2020 May;29(3):269-276. doi: 10.1136/tobaccocontrol-2019-054948. Epub 2019 May 30.
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Population attributable fractions for risk factors for dementia in low-income and middle-income countries: an analysis using cross-sectional survey data.低收入和中等收入国家痴呆风险因素的人群归因分数:使用横断面调查数据进行的分析。
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Reducing the Number of People with Dementia Through Primary Prevention in Mozambique, Brazil, and Portugal: An Analysis of Population-Based Data.通过在莫桑比克、巴西和葡萄牙进行初级预防来减少痴呆患者人数:基于人群数据的分析。
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Racial and ethnic differences in trends in dementia prevalence and risk factors in the United States.美国痴呆症患病率和风险因素趋势中的种族和民族差异。
Alzheimers Dement (N Y). 2018 Oct 5;4:510-520. doi: 10.1016/j.trci.2018.08.009. eCollection 2018.
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美国按性别、种族和族裔划分的与阿尔茨海默病及相关痴呆症相关的风险因素。

Risk Factors Associated With Alzheimer Disease and Related Dementias by Sex and Race and Ethnicity in the US.

机构信息

Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles.

California Center for Population Research, University of California, Los Angeles.

出版信息

JAMA Neurol. 2022 Jun 1;79(6):584-591. doi: 10.1001/jamaneurol.2022.0976.

DOI:10.1001/jamaneurol.2022.0976
PMID:35532912
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9086930/
Abstract

IMPORTANCE

Previous estimates suggested that 1 in 3 cases of Alzheimer disease and related dementia (ADRDs) in the US are associated with modifiable risk factors, the most prominent being physical inactivity, depression, and smoking. However, these estimates do not account for changes in risk factor prevalence over the past decade and do not consider potential differences by sex or race and ethnicity.

OBJECTIVE

To update estimates of the proportion of ADRDs in the US that are associated with modifiable risk factors and to assess for differences by sex and race and ethnicity.

DESIGN, SETTING, AND PARTICIPANTS: For this cross-sectional study, risk factor prevalence and communality were obtained from the nationally representative US Behavioral Risk Factor Surveillance Survey data from January 2018 to December 2018, and relative risks for each risk factor were extracted from meta-analyses. Data were analyzed from December 2020 to August 2021. Respondents included 378 615 noninstitutionalized adults older than 18 years. The number before exclusion was 402 410. Approximately 23 795 (~6%) had missing values on at least 1 of the variables of interest.

EXPOSURES

Physical inactivity, current smoking, depression, low education, diabetes, midlife obesity, midlife hypertension, and hearing loss.

MAIN OUTCOMES AND MEASURES

Individual and combined population-attributable risks (PARs) associated with ADRDs, accounting for nonindependence between risk factors.

RESULTS

Among 378 615 individuals, 171 161 (weighted 48.7%) were male, and 134 693 (weighted 21.1%) were 65 years and older. Race and ethnicity data were self-reported and defined by the US Behavioral Risk Factor Surveillance System Data; 6671 participants (weighted 0.9%) were American Indian and Alaska Native, 8043 (weighted 5.1%) were Asian, 29 956 (weighted 11.7%) were Black, 28 042 (weighted 16.0%) were Hispanic (any race), and 294 394 (weighted 64.3%) were White. Approximately 1 in 3 of ADRD cases (36.9%) in the US were associated with 8 modifiable risk factors, the most prominent of which were midlife obesity (17.7%; 95% CI, 17.5-18.0), physical inactivity (11.8%; 95% CI, 11.7-11.9), and low educational attainment (11.7%; 95% CI, 11.5-12.0). Combined PARs were higher in men (35.9%) than women (30.1%) and differed by race and ethnicity: American Indian and Alaska Native individuals, 39%; Asian individuals, 16%; Black individuals, 40%; Hispanic individuals (any race), 34%; and White individuals, 29%. The most prominent modifiable risk factors regardless of sex were midlife obesity for American Indian and Alaska Native individuals, Black individuals, and White individuals; low education for Hispanic individuals; and physical inactivity for Asian individuals.

CONCLUSIONS AND RELEVANCE

The findings suggest that risk factors associated with ADRDs have changed over the past decade and differ based on sex and race and ethnicity. Alzheimer risk reduction strategies may be more effective if they target higher-risk groups and consider current risk factor profiles.

摘要

重要性

先前的估计表明,美国 3 例阿尔茨海默病和相关痴呆症(ADRD)病例中,有 1 例与可改变的危险因素有关,其中最明显的是身体活动不足、抑郁和吸烟。然而,这些估计没有考虑到过去十年风险因素流行率的变化,也没有考虑到性别、种族和民族潜在的差异。

目的

更新美国 ADRD 中与可改变的危险因素相关的比例的估计,并评估性别和种族和民族的差异。

设计、地点和参与者:对于这项横断面研究,风险因素的流行率和公共性是从 2018 年 1 月至 12 月期间具有全国代表性的美国行为风险因素监测调查数据中获得的,每个风险因素的相对风险是从荟萃分析中提取的。数据分析于 2020 年 12 月至 2021 年 8 月进行。受访者包括 378615 名年龄在 18 岁以上的非住院成年人。排除前的数据为 402410。大约有 23795 人(约 6%)至少有 1 个感兴趣的变量缺失值。

暴露

身体活动不足、当前吸烟、抑郁、低教育程度、糖尿病、中年肥胖、中年高血压和听力损失。

主要结果和措施

与 ADRD 相关的个体和综合人群归因风险(PAR),考虑到风险因素之间的非独立性。

结果

在 378615 名个体中,171161 人(加权 48.7%)为男性,134693 人(加权 21.1%)为 65 岁及以上。种族和民族数据是自我报告的,并由美国行为风险因素监测系统数据定义;6671 名参与者(加权 0.9%)为美国印第安人和阿拉斯加原住民,8043 名(加权 5.1%)为亚洲人,29956 名(加权 11.7%)为黑人,28042 名(加权 16.0%)为西班牙裔(任何种族),294394 名(加权 64.3%)为白人。在美国,大约 1/3 的 ADRD 病例(36.9%)与 8 个可改变的危险因素有关,其中最明显的是中年肥胖(17.7%;95%CI,17.5-18.0)、身体活动不足(11.8%;95%CI,11.7-11.9)和低教育程度(11.7%;95%CI,11.5-12.0)。男性的合并 PAR (35.9%)高于女性(30.1%),且存在差异,按种族和民族划分:美国印第安人和阿拉斯加原住民个体为 39%;亚洲人个体为 16%;黑人个体为 40%;西班牙裔(任何种族)个体为 34%;白人个体为 29%。无论性别如何,最明显的可改变危险因素都是美国印第安人和阿拉斯加原住民个体、黑人个体和白人个体的中年肥胖;西班牙裔个体的低教育程度;以及亚洲个体的身体活动不足。

结论和相关性

研究结果表明,过去十年中与 ADRD 相关的风险因素发生了变化,且因性别和种族和民族而异。如果阿尔茨海默病风险降低策略能够针对高风险群体,并考虑当前的风险因素状况,那么可能会更加有效。