Ferguson Erin L, Vittinghoff Eric, Zeki Al Hazzouri Adina, Allen Norrina, Fitzpatrick Annette, Yaffe Kristine
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States.
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States.
Front Dement. 2023 Jun 29;2:1215904. doi: 10.3389/frdem.2023.1215904. eCollection 2023.
Racial disparities in dementia outcomes persist in the United States. Targeting modifiable risk factors, including cardiovascular risk factors (CVRFs), is a conceivable way to reduce health disparities. Life course CVRFs are often higher in non-White adults and are associated with risk of dementia, but it is unknown whether they contribute to racial disparities in dementia and cognition.
Using a pooled cohort of 4,159 White and 939 Black participants aged 65-95 years, we conducted a mediation analysis to estimate the proportional effect of race on dementia that is explained by four CVRFs imputed over the life course (20-49, 50-69, and 70-89 years of age): body mass index, fasting glucose, systolic blood pressure, and low-density lipoprotein cholesterol.
Compared to White participants, Black participants had greater risk of dementia (adjusted OR = 1.37; 95% CI: 1.17-1.60). BMI and fasting glucose over the life course were significant mediators of the effect of race on dementia risk, mediating 39.1% (95% CI: 10.5-67.8%) and 8.2% (95% CI: 0.1-16.2%) of the effect, adjusted for sex and age. All four CVRFs together were also significant mediators of the effect of race on scores on global cognition and processing speed, accounting for approximately 11% of the effect.
We found that CVRFs across the life course partially explain disparities in dementia risk and cognition in late-life. Improved prevention and treatment of CVRFs across the life course may be important to reduce health disparities for dementia.
在美国，痴呆症结局方面的种族差异依然存在。针对可改变的风险因素，包括心血管风险因素（CVRF），是减少健康差异的一种可行方法。非白人成年人的生命历程CVRF往往更高，且与痴呆症风险相关，但尚不清楚它们是否导致痴呆症和认知方面的种族差异。
我们使用了一个由4159名65 - 95岁白人参与者和939名黑人参与者组成的合并队列，进行了一项中介分析，以估计种族对痴呆症的比例效应，该效应由生命历程（20 - 49岁、50 - 69岁和70 - 89岁）中推算出的四种CVRF解释：体重指数、空腹血糖、收缩压和低密度脂蛋白胆固醇。
与白人参与者相比，黑人参与者患痴呆症的风险更高（调整后的优势比 = 1.37；95%置信区间：1.17 - 1.60）。生命历程中的体重指数和空腹血糖是种族对痴呆症风险影响的显著中介因素，在调整性别和年龄后，分别介导了该效应的39.1%（95%置信区间：10.5 - 67.8%）和8.2%（95%置信区间：0.1 - 16.2%）。所有四种CVRF共同也是种族对整体认知和处理速度得分影响的显著中介因素，约占该效应的11%。
我们发现生命历程中的CVRF部分解释了晚年痴呆症风险和认知方面的差异。改善生命历程中CVRF的预防和治疗对于减少痴呆症的健康差异可能很重要。
