International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK.
International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK.
Lancet. 2023 Nov;402 Suppl 1:S34. doi: 10.1016/S0140-6736(23)02078-0.
Dementia's growing impact, especially in ageing societies such as the UK, emphasises the importance of modifiable risk factors as primary prevention targets. Despite this, the temporal progression and the population attributable fraction (PAF) of dementia attributable to these factors remain unclear. This investigation aims to examine the temporal trajectories of the modifiable risk factors for dementia in England from 2004 to 2019.
We used data from the English Longitudinal Study of Ageing collected between June, 2004, and July, 2019, covering 76 904 participants. We calculated the PAFs for 12 modifiable risk factors, as recommended by the Lancet Commission on dementia prevention, intervention, and care, and the individual weighted PAFs (IW-PAFs) for each risk factor. We analysed temporal trends to understand the changes in the overall PAF and IW-PAF over the study period.
The overall PAF for dementia showed a decrease from 46·31% in 2004-05 to 43·95% in 2018-19, but this trend was not significant (p=0·226). Hypertension, with an average IW-PAF of 8·67%, has been the primary modifiable determinant of dementia, trailed by obesity (6·42%), social isolation (5·84%), hearing loss (5·02%), depression (4·89%), low education (4·80%), physical inactivity (3·40%), diabetes (2·61%), smoking (2·08%), excessive alcohol consumption (1·22%), air pollution (0·44%), and traumatic brain injury (0·28%). During 2004-19, only IW-PAFs of low education (p=0·001), social isolation (p=0·034), and smoking (p=0·007) showed significant decreasing trends, whereas IW-PAFs of other factors had either stagnated with insignificant changes or, worryingly, climbed upwards.
This investigation provides valuable insights into the temporal trends of modifiable risk factors for dementia in England. The observed trends underscore the continuing relevance of these risk factors and the need for targeted public health strategies to address them. Notable, PAF was based on a theoretical scenario in which dementia risk can be wholly eliminated by removing risk factors, which should be explained with caution in practice.
UK Foreign, Commonwealth and Development Office; National Institute for Health and Care Research (NIHR).
痴呆症的影响日益严重，尤其是在英国等老龄化社会，这凸显了可改变的风险因素作为一级预防目标的重要性。尽管如此，这些因素导致痴呆症的时间进程和人群归因分数（PAF）仍不清楚。本研究旨在探讨 2004 年至 2019 年期间英格兰可改变的痴呆症风险因素的时间轨迹。
我们使用了 2004 年 6 月至 2019 年 7 月期间在英国进行的纵向老龄化研究（ELSA）的数据，涵盖了 76904 名参与者。我们根据 Lancet Commission on dementia prevention, intervention, and care 建议，计算了 12 种可改变的风险因素的 PAF，并计算了每个风险因素的个体加权 PAF（IW-PAF）。我们分析了时间趋势，以了解研究期间总体 PAF 和 IW-PAF 的变化。
痴呆症的总体 PAF 从 2004-05 年的 46.31%下降到 2018-19 年的 43.95%，但这一趋势并不显著（p=0.226）。高血压是痴呆症的主要可改变决定因素，平均 IW-PAF 为 8.67%，其次是肥胖（6.42%）、社会孤立（5.84%）、听力损失（5.02%）、抑郁（4.89%）、低教育（4.80%）、身体不活动（3.40%）、糖尿病（2.61%）、吸烟（2.08%）、过度饮酒（1.22%）、空气污染（0.44%）和创伤性脑损伤（0.28%）。在 2004-19 年期间，只有低教育的 IW-PAF（p=0.001）、社会孤立（p=0.034）和吸烟（p=0.007）显示出显著的下降趋势，而其他因素的 IW-PAF 要么保持不变，要么令人担忧地上升。
本研究提供了英格兰痴呆症可改变风险因素的时间趋势的有价值的见解。观察到的趋势强调了这些风险因素的持续相关性，以及需要采取有针对性的公共卫生策略来解决这些因素。值得注意的是，PAF 是基于一种理论情景，即通过消除风险因素可以完全消除痴呆症风险，但在实践中应谨慎解释。
英国外交、联邦和发展办公室；国家卫生与保健研究所（NIHR）。
