Aravena José M, Chen Xi, Levy Becca R
Department of Social & Behavioral Sciences, School of Public Health, Yale University, New Haven, Connecticut, USA.
Instituto de Investigación y Postgrado, Facultad de Ciencias de la Salud, Universidad Central de Chile, Santiago, Chile.
J Am Geriatr Soc. 2024 Jul;72(7):2126-2132. doi: 10.1111/jgs.18842. Epub 2024 Feb 28.
Low healthcare quality has been found to predict the development of a number of illnesses in older adults. However, it has not been investigated as a determinant of dementia. Thus, the goal of this study was to assess whether experiencing low healthcare quality is associated with developing dementia in people aged 60 and older.
Participants in the Health and Retirement Study, without dementia and aged 60 and older at baseline, were followed from 2006 to 2019. Experiencing low healthcare quality was assessed at baseline through questions about healthcare discrimination and dissatisfaction with healthcare services. The outcome, development of new cases of dementia, was determined through physician diagnosis or a cognition score compatible with dementia (assessed by the Telephone Interview for Cognitive Status). Cox regression was used to estimate the hazard ratio (HR) of dementia, adjusting for participants' demographic, health, and socioeconomic factors.
Among the 3795 participants included in the cohort, 700 developed dementia. Experiencing low healthcare quality was associated with increased dementia risk over 12 years (unadjusted HR: 1.68, 95% CI: 1.27-2.21, p-value <0.001; fully adjusted HR: 1.50, 95% CI: 1.12-2.01, p-value: 0.006). Healthcare discrimination and dissatisfaction with the healthcare quality received were independently associated with increased dementia risk.
As predicted, experiencing low healthcare quality was associated with greater dementia risk. To date, most measures to reduce dementia have focused on individual-level behaviors. Our findings suggest that implementing structural changes to improve healthcare quality delivery for older persons could reduce dementia prevalence.
研究发现，医疗保健质量低下预示着老年人多种疾病的发生。然而，尚未将其作为痴呆症的一个决定因素进行研究。因此，本研究的目的是评估医疗保健质量低下是否与60岁及以上人群患痴呆症有关。
对健康与退休研究中的参与者进行随访，这些参与者在基线时无痴呆症且年龄在60岁及以上，随访时间为2006年至2019年。在基线时，通过关于医疗保健歧视和对医疗服务不满的问题来评估医疗保健质量低下的情况。通过医生诊断或与痴呆症相符的认知评分（由认知状态电话访谈评估）来确定痴呆症新病例的发生情况。使用Cox回归来估计痴呆症的风险比（HR），并对参与者的人口统计学、健康和社会经济因素进行调整。
在该队列纳入的3795名参与者中，700人患上了痴呆症。在12年的时间里，经历低医疗保健质量与痴呆症风险增加有关（未调整的HR：1.68，95%CI：1.27-2.21，p值<0.001；完全调整后的HR：1.50，95%CI：1.12-2.01，p值：0.006）。医疗保健歧视和对所接受医疗保健质量的不满与痴呆症风险增加独立相关。
正如预期的那样，经历低医疗保健质量与更高的痴呆症风险相关。迄今为止，大多数减少痴呆症的措施都集中在个人层面的行为上。我们的研究结果表明，实施结构性变革以改善老年人的医疗保健质量提供情况，可能会降低痴呆症的患病率。
