英格兰和威尔士的痴呆症发病趋势，2002-19 年，以及到 2040 年痴呆症负担的预测：来自英国老龄化纵向研究的数据分析。
Dementia incidence trend in England and Wales, 2002-19, and projection for dementia burden to 2040: analysis of data from the English Longitudinal Study of Ageing.
机构信息
Department of Epidemiology and Public Health, University College London, London, UK.
Division of Prevention Medicine & Education, Medical University of Gdansk, Gdansk, Poland.
出版信息
Lancet Public Health. 2023 Nov;8(11):e859-e867. doi: 10.1016/S2468-2667(23)00214-1.
BACKGROUND
Dementia incidence declined in many high-income countries in the 2000s, but evidence on the post-2010 trend is scarce. We aimed to analyse the temporal trend in England and Wales between 2002 and 2019, considering bias and non-linearity.
METHODS
Population-based panel data representing adults aged 50 years and older from the English Longitudinal Study of Ageing were linked to the mortality register across wave 1 (2002-03) to wave 9 (2018-19) (90 073 person observations). Standard criteria based on cognitive and functional impairment were used to ascertain incident dementia. Crude incidence rates were determined in seven overlapping initially dementia-free subcohorts each followed up for 4 years (ie, 2002-06, 2004-08, 2006-10, 2008-12, 2010-14, 2012-16, and 2014-18). We examined the temporal trend of dementia incidence according to age, sex, and educational attainment. We estimated the trend of dementia incidence adjusted by age and sex with Cox proportional hazards and multistate models. Restricted cubic splines allowed for potential non-linearity in the time trend. A Markov model was used to project future dementia burden considering the estimated incidence trend.
FINDINGS
Incidence rate standardised by age and sex declined from 2002 to 2010 (from 10·7 to 8·6 per 1000 person-years), then increased from 2010 to 2019 (from 8·6 to 11·3 per 1000 person-years). Adjusting for age and sex, and accounting for missing dementia cases due to death, estimated dementia incidence declined by 28·8% from 2002 to 2008 (incidence rate ratio 0·71, 95% CI 0·58-0·88), and increased by 25·2% from 2008 to 2016 (1·25, 1·03-1·54). The group with lower educational attainment had a smaller decline in dementia incidence from 2002 to 2008 and a greater increase after 2008. If the upward incidence trend continued, there would be 1·7 million (1·62-1·75) dementia cases in England and Wales by 2040, 70% more than previously forecast.
INTERPRETATION
Dementia incidence might no longer be declining in England and Wales. If the upward trend since 2008 continues, along with population ageing, the burden on health and social care will be large.
FUNDING
UK Economic and Social Research Council.
背景
在 21 世纪 00 年代，许多高收入国家的痴呆症发病率有所下降，但关于 2010 年后趋势的证据很少。我们旨在分析 2002 年至 2019 年期间英格兰和威尔士的时间趋势，同时考虑到偏差和非线性。
方法
基于年龄在 50 岁及以上的成年人的人口基础面板数据，代表来自英国老龄化纵向研究的成年人，与死亡率登记处进行了关联，跨越了第 1 波（2002-03 年）至第 9 波（2018-19 年）（90073 人观察）。根据认知和功能障碍的标准，确定了新出现的痴呆症。在七个最初无痴呆的亚队列中，每个队列都进行了 4 年的随访，确定了粗发病率（即 2002-06、2004-08、2006-10、2008-12、2010-14、2012-16 和 2014-18）。我们根据年龄、性别和教育程度来检查痴呆症发病率的时间趋势。我们使用 Cox 比例风险和多状态模型来估计年龄和性别调整后的痴呆症发病率趋势。受限三次样条允许时间趋势存在潜在的非线性。使用马尔可夫模型考虑估计的发病率趋势来预测未来的痴呆症负担。
结果
标准化后的年龄和性别发病率从 2002 年到 2010 年下降（从每 1000 人年 10.7 例降至 8.6 例），然后从 2010 年上升至 2019 年（从每 1000 人年 8.6 例上升至 11.3 例）。在调整年龄和性别，并考虑因死亡而导致的痴呆病例缺失后，2002 年至 2008 年估计的痴呆发病率下降了 28.8%（发病率比为 0.71，95%CI 0.58-0.88），而 2008 年至 2016 年则上升了 25.2%（1.25，1.03-1.54）。教育程度较低的群体，在 2002 年至 2008 年期间，痴呆症发病率下降幅度较小，而在 2008 年之后，发病率上升幅度较大。如果发病率上升的趋势持续下去，到 2040 年，英格兰和威尔士的痴呆症病例将达到 170 万（1.62-1.75），比之前预测的增加了 70%。
解释
痴呆症的发病率在英格兰和威尔士可能不再下降。如果自 2008 年以来的上升趋势持续下去，再加上人口老龄化，对卫生和社会保健的负担将很大。
资助
英国经济和社会研究理事会。
Zotero 插件