风险因素、种族和痴呆症：英国生物银行中白种人、南亚裔和黑种人参与者的前瞻性队列研究。
Risk factors, ethnicity and dementia: A UK Biobank prospective cohort study of White, South Asian and Black participants.
机构信息
Division of Psychiatry, University College London, London, Greater London, United Kingdom.
Camden and Islington NHS Foundation Trust, London, Greater London, United Kingdom.
出版信息
PLoS One. 2022 Oct 12;17(10):e0275309. doi: 10.1371/journal.pone.0275309. eCollection 2022.
BACKGROUND
Our knowledge of the effect of potentially modifiable risks factors on people developing dementia is mostly from European origin populations. We aimed to explore if these risk factors had similar effects in United Kingdom (UK) White, South Asian and Black UK Biobank participants recruited from 2006-2010 and followed up until 2020.
METHODS
We reviewed the literature to 25.09.2020 for meta-analyses identifying potentially modifiable risk factors preceding dementia diagnosis by ≥10 years. We calculated prevalence of each identified risk factor and association with dementia for participants aged ≥55 at registration in UK Biobank. We calculated hazard ratios using Cox regression for each risk factor, stratified by ethnic group, and tested for differences using interaction effects between each risk factor and ethnicity.
FINDINGS
We included education, hearing loss, hypertension, obesity, excess alcohol consumption, physical inactivity, smoking, high total cholesterol, depression, diabetes, social isolation, and air pollution as risks. Out of 294,162 participants, there were 287,806 White, 3590 South Asian and 2766 Black people, followed up for up to 14.8 years, with a total follow-up time of 3,392,095 years. During follow-up, 5,972 people (2.03%) developed dementia. Risk of dementia was higher in Black participants than White participants (HR for dementia compared to White participants as reference 1.43, 95% CI 1.16-1.77, p = 0.001) but South Asians had a similar risk. Association between each risk factor and dementia was similar in each ethnic group with no evidence to support any differences.
INTERPRETATION
We find that Black participants were more likely to develop dementia than White participants, but South Asians were not. Identified risk factors in White European origin participants had a similar effect in Black and South Asian origin participants. Volunteers in UK Biobank are not representative of the population and interaction effects were underpowered so further work is needed.
背景
我们对可改变的潜在风险因素对人们患痴呆症的影响的了解主要来自欧洲人群。我们旨在探索这些风险因素在英国（英国）白种人、南亚裔和黑人 UK Biobank 参与者中是否有类似的影响，这些参与者是在 2006-2010 年招募的，并随访至 2020 年。
方法
我们检索了截止到 2020 年 9 月 25 日的文献，以寻找在 UK Biobank 注册时年龄≥55 岁的参与者中，至少提前 10 年确诊痴呆症的潜在可改变风险因素的荟萃分析。我们计算了每个已确定风险因素的患病率，并评估了其与痴呆症的相关性。我们使用 Cox 回归计算了每个风险因素的风险比，按种族分层，并通过每个风险因素与种族之间的交互作用来检验差异。
结果
我们将教育、听力损失、高血压、肥胖、过度饮酒、身体不活动、吸烟、高总胆固醇、抑郁、糖尿病、社会隔离和空气污染等作为风险因素。在 294162 名参与者中，有 287806 名白人、3590 名南亚裔和 2766 名黑人，随访时间最长为 14.8 年，总随访时间为 3392095 年。在随访期间，有 5972 人（2.03%）发生痴呆症。与白人参与者相比，黑人参与者患痴呆症的风险更高（痴呆症的 HR 与白人参与者相比为 1.43，95%CI 为 1.16-1.77，p=0.001），但南亚裔的风险相似。在每个种族群体中，每个风险因素与痴呆症之间的关联相似，没有证据支持任何差异。
解释
我们发现黑人参与者比白人参与者更容易患痴呆症，但南亚裔人并非如此。在白人欧洲裔参与者中确定的风险因素在黑人参与者和南亚裔参与者中也有类似的效果。UK Biobank 的志愿者不能代表人群，交互作用的影响也没有足够的效力，因此需要进一步的工作。
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