Chen Shanquan, Chen Xi, Hou Xiaohui, Fang Hai, Liu Gordon G, Yan Lijing L
International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom.
Institute for Global Health and Development, Peking University, Beijing, China.
Lancet Reg Health West Pac. 2024 May 29;47:101106. doi: 10.1016/j.lanwpc.2024.101106. eCollection 2024 Jun.
BACKGROUND: In China, dementia poses a significant public health challenge, exacerbated by an ageing population and lifestyle changes. This study assesses the temporal trends and disparities in the population-attributable fractions (PAFs) of modifiable risk factors (MRFs) for new-onset dementia from 2011 to 2018. METHODS: We used data from the China Health and Retirement Longitudinal Study (CHARLS), covering 75,214 person-waves. We calculated PAFs for 12 MRFs identified by the Lancet Commission (including six early-to mid-life factors and six late-life factors). We also determined the individual weighted PAFs (IW-PAFs) for each risk factor. Subgroup analyses were conducted by sex, socio-economic status (SES), and geographic location. FINDINGS: The overall PAF for dementia MRFs had a slight increase from 45.36% in 2011 to 52.46% in 2018, yet this change wasn't statistically significant. During 2011-2018, the most contributing modifiable risk was low education (average IW-PAF 11.3%), followed by depression, hypertension, smoking, and physical inactivity. Over the eight-year period, IW-PAFs for risk factors like low education, hypertension, hearing loss, smoking, and air pollution showed decreasing trends, while others increased, but none of these changes were statistically significant. Sex-specific analysis revealed higher IW-PAFs for traumatic brain injury (TBI), social isolation, and depression in women, and for alcohol and smoking in men. The decline in IW-PAF for men's hearing loss were significant. Lower-income individuals had higher overall MRF PAFs, largely due to later-life factors like depression. Early-life factors, such as TBI and low education, also contributed to SES disparities. Rural areas reported higher overall MRF PAFs, driven by factors like depression, low education, and hearing loss. The study also found that the gap in MRF PAFs across different SES groups or regions either remained constant or increased over the study period. INTERPRETATION: The study reveals a slight but non-significant increase in dementia's MRF PAF in China, underscoring the persistent relevance of these risk factors. The findings highlight the need for targeted public health strategies, considering the demographic and regional differences, to effectively tackle and reduce dementia risk in China's diverse population. FUNDING: This work was supported by the PKU Young Scholarship in Global Health and Development.
背景:在中国,人口老龄化和生活方式的改变加剧了痴呆症对公共卫生的重大挑战。本研究评估了2011年至2018年新发痴呆症可改变风险因素(MRF)的人群归因分数(PAF)的时间趋势和差异。 方法:我们使用了中国健康与养老追踪调查(CHARLS)的数据,涵盖75214人次。我们计算了《柳叶刀》委员会确定的12种MRF的PAF(包括6种早年至中年因素和6种晚年因素)。我们还确定了每种风险因素的个体加权PAF(IW-PAF)。按性别、社会经济地位(SES)和地理位置进行亚组分析。 结果:痴呆症MRF的总体PAF从2011年的45.36%略有增加到2018年的52.46%,但这一变化无统计学意义。在2011 - 2018年期间,最主要的可改变风险因素是低教育程度(平均IW-PAF为11.3%),其次是抑郁、高血压、吸烟和身体活动不足。在这八年期间,低教育程度、高血压、听力损失、吸烟和空气污染等风险因素的IW-PAF呈下降趋势,而其他因素呈上升趋势,但这些变化均无统计学意义。按性别分析显示,女性脑外伤(TBI)、社会隔离和抑郁的IW-PAF较高,男性则是酒精和吸烟的IW-PAF较高。男性听力损失的IW-PAF下降显著。低收入个体的总体MRF PAF较高,主要是由于抑郁等晚年因素。早年因素,如TBI和低教育程度,也导致了SES差异。农村地区报告的总体MRF PAF较高,原因是抑郁、低教育程度和听力损失等因素。研究还发现,在研究期间,不同SES组或地区之间的MRF PAF差距要么保持不变,要么有所增加。 解读:该研究揭示了中国痴呆症MRF PAF略有增加但无统计学意义,强调了这些风险因素的持续相关性。研究结果凸显了制定有针对性的公共卫生策略的必要性,需考虑人口和地区差异,以有效应对和降低中国不同人群的痴呆症风险。 资助:本研究得到了北京大学全球健康与发展青年奖学金的支持。
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