Bothongo Phazha L K, Jitlal Mark, Parry Eve, Waters Sheena, Foote Isabelle F, Watson Cameron J, Cuzick Jack, Giovannoni Gavin, Dobson Ruth, Noyce Alastair J, Mukadam Naaheed, Bestwick Jonathan P, Marshall Charles R
Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK.
Department of Neurology, Barts Health NHS Trust, London, UK.
Lancet Reg Health Eur. 2022 Feb 11;15:100321. doi: 10.1016/j.lanepe.2022.100321. eCollection 2022 Apr.
Most evidence about dementia risk comes from relatively affluent people of White European ancestry. We aimed to determine the association between ethnicity, area level socioeconomic deprivation and dementia risk, and the extent to which variation in risk might be attributable to known modifiable clinical risk factors and health behaviours.
In this nested case-control study, we analysed data from primary care medical records of a population of 1,016,277 from four inner East London boroughs, United Kingdom, collected between 2009 and 2018. The outcome measures were odds ratios for dementia according to ethnicity and deprivation, before and after the addition of major modifiable risk factors for dementia; and weighted population attributable risk for comparison between individual risk factors.
We identified 4137 dementia cases and 15,754 matched controls (mean age for cases and controls were 80·7 years, (SD 8·7); 81·3 years, (SD 8·9) respectively, range 27-103). Black and South Asian ethnicity were both associated with increased risk of dementia relative to White (odds ratios [95% CI]: Black 1·43 [1·31-1·56]; South Asian 1.17 [1·06-1·29]). Area-level deprivation was independently associated with an increased risk of dementia in a dose-dependent manner. Black and South Asian ethnicity were both associated with a younger age at dementia diagnosis (odds ratios [95%CI]: 0·70 [0·61-0·80] and 0·55 [0·47-0·65], respectively). Population attributable risk was higher for ethnicity (9·7%) and deprivation (11·7%) than for any established modifiable risk factor in this population.
Ethnicity and area-level deprivation are independently associated with dementia risk in East London. This effect may not be attributable to the effect of known risk factors.
Barts Charity (MGU0366).
大多数关于痴呆风险的证据来自欧洲裔白人中相对富裕的人群。我们旨在确定种族、地区层面的社会经济剥夺与痴呆风险之间的关联，以及风险差异在多大程度上可能归因于已知的可改变的临床风险因素和健康行为。
在这项巢式病例对照研究中，我们分析了来自英国东伦敦四个内城区1,016,277人的初级保健医疗记录数据，这些数据收集于2009年至2018年之间。结局指标是在纳入主要的可改变的痴呆风险因素之前和之后，根据种族和剥夺情况得出的痴呆比值比；以及用于个体风险因素比较的加权人群归因风险。
我们识别出4137例痴呆病例和15,754例匹配对照（病例组和对照组的平均年龄分别为80.7岁（标准差8.7）；81.3岁（标准差8.9），年龄范围为27 - 103岁）。与白人相比，黑人及南亚裔种族患痴呆的风险均增加（比值比[95%置信区间]：黑人1.43[1.31 - 1.56]；南亚裔1.17[1.06 - 1.29]）。地区层面的剥夺与痴呆风险增加独立相关，且呈剂量依赖性。黑人及南亚裔种族在痴呆诊断时的年龄均较小（比值比[95%置信区间]：分别为0.70[0.61 - 0.80]和0.55[0.47 - 0.65]）。在该人群中，种族（9.7%）和剥夺（11.7%）的人群归因风险高于任何已确定的可改变风险因素。
在东伦敦，种族和地区层面的剥夺与痴呆风险独立相关。这种影响可能并非归因于已知风险因素的作用。
巴茨慈善机构（MGU0366）
