Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Eur J Epidemiol. 2022 Aug;37(8):807-814. doi: 10.1007/s10654-022-00878-1. Epub 2022 Jun 22.
There is need for accurate projections of the future dementia burden to prepare healthcare systems and policymakers. Existing projections only account for population ageing, not for observed declines in age-specific dementia incidence of 13% per decade. We developed a dementia microsimulation model that synthesizes population-based data from the Rotterdam Study with changes in demographics between birth cohorts from the early 1900s onwards. We determined dementia prevalence and incidence until 2050 for three different dementia incidence trend scenarios: (1) stable age-specific incidence, (2) linear decline by 13% per decade, (3) nonlinear declines averaging 13% per decade. Assuming a stable age-specific incidence resulted in a 130% increase in incidence and 118% in prevalence between 2020 and 2050. By contrast, the linearly declining trend resulted in substantially smaller increases of 58% in incidence (95%CI: 29-87%), and 43% in prevalence (95%CI: 13-66%), corresponding to 39% lower incidence and 36% lower prevalence by 2050 than in the stable-incidence scenario. Results for various non-linear declines fell between the stable and linear trend. The future burden of dementia is highly susceptible to achievable changes in age-specific incidence. Extension of previously established secular trends globally would reduce widely upheld projections of new dementia cases until 2050 by 39%.
需要准确预测未来的痴呆症负担，以准备医疗保健系统和政策制定者。现有的预测仅考虑了人口老龄化，而没有考虑到每十年观察到的特定年龄组痴呆症发病率下降 13%。我们开发了一种痴呆症微观模拟模型，该模型综合了 Rotterdam 研究的基于人群的数据，以及自 20 世纪初以来各出生队列之间人口统计学变化的数据。我们确定了三种不同的痴呆症发病率趋势情景下（1）特定年龄组发病率稳定，（2）每十年线性下降 13%，（3）平均每十年非线性下降 13%），直到 2050 年的痴呆症患病率和发病率。假设特定年龄组的发病率稳定，那么在 2020 年至 2050 年期间，发病率将增加 130%，患病率将增加 118%。相比之下，线性下降趋势导致发病率的增幅要小得多，为 58%（95%CI：29-87%），患病率的增幅为 43%（95%CI：13-66%），到 2050 年，发病率比稳定发病率情景低 39%，患病率低 36%。各种非线性下降的结果都介于稳定和线性趋势之间。痴呆症的未来负担极易受到特定年龄组发病率变化的影响。在全球范围内延长以前确立的长期趋势，将使到 2050 年新的痴呆症病例的广泛预期减少 39%。
