Department of Mathematics and Statistics, North Carolina Agricultural & Technical State University, Greensboro, North Carolina, United States of America.
Department of Statistics, Sungshin Women's University, Seoul, Republic of Korea.
PLoS One. 2024 Sep 13;19(9):e0310102. doi: 10.1371/journal.pone.0310102. eCollection 2024.
Subjective cognitive decline (SCD) is one of the most important early onset symptoms of Alzheimer's Disease. Previous studies consistently reported that SCD is associated with quality of life, socio-economic factors, and related health comorbidities. However, the impact of veteran status on SCD has been little investigated. This study conducted a cross-sectional study to address disproportionate effects in subjective cognitive decline between veterans and non-veterans in the United States. Propensity score matching (PSM) was applied in this observational study to achieve covariate balancing and reduce selection bias, providing a more accurate estimate of the isolated effect of veteran status on SCD. Our study utilized 32,431 forty-five years or older non-institutionalized White, Black or African-American, and Hispanic or Latin-American male population from the 2019 Behavioral Risk Factor Surveillance System data. We first identified 10,685 paired PSM samples for the binary veteran status using the preselected covariates. Next, we performed a logistic regression for modeling the relationship between the veteran status and the SCD status using the PSM samples along with the covariates selected by a BIC-based stepwise selection. Our analyses revealed a statistically significant causal association between veteran status and SCD after PSM (odds ratio (OR): 1.16 and 95% confidence interval (CI): 1.06-1.27). We obtained a similar result before PSM with an OR of 1.20 and 95% CI of 1.10-1.31. When we focused on a minority group (Black or African-American males), we found a significantly increased veterans' risk of SCD, especially after propensity score matching (OR: 1.69, 95% CI: 1.16-2.45). We also found several factors such as employment status, difficulty dressing/walking/running errands, general health status, physical health status, unaffordability of medical costs, mental health status, and comorbid conditions including stroke, blindness, high cholesterol, and arthritis as statistically significantly associated with SCD (P-value < 0.05). Similar to post-traumatic stress disorder and traumatic brain injury, our study demonstrated a causal association between SCD and military-related activities in the United States, which has a disproportionate impact on the minority population. This study sets the groundwork to further research in this domain to diagnose neurological diseases early among veterans.
主观认知衰退（SCD）是阿尔茨海默病的最重要早期发病症状之一。先前的研究一致表明，SCD 与生活质量、社会经济因素和相关健康合并症有关。然而，退伍军人身份对 SCD 的影响却很少被研究。本研究通过横断面研究来解决美国退伍军人和非退伍军人之间 SCD 不成比例的影响。在这项观察性研究中应用倾向评分匹配（PSM）以实现协变量平衡并减少选择偏差，从而更准确地估计退伍军人身份对 SCD 的孤立影响。我们的研究利用了 2019 年行为风险因素监测系统数据中来自四十五岁或以上的非机构化的白人、黑人或非裔美国人以及西班牙裔或拉丁裔美国男性的 32431 个样本。我们首先使用预先选择的协变量为二元退伍军人身份确定了 10685 对匹配的 PSM 样本。接下来，我们使用 PSM 样本以及基于 BIC 的逐步选择选择的协变量对退伍军人身份和 SCD 状态之间的关系进行了逻辑回归建模。我们的分析表明，在 PSM 后退伍军人身份与 SCD 之间存在统计学上显著的因果关系（比值比（OR）：1.16，95%置信区间（CI）：1.06-1.27）。在 PSM 之前，我们也得到了类似的结果，OR 为 1.20，95% CI 为 1.10-1.31。当我们关注少数群体（黑人或非裔美国男性）时，我们发现退伍军人患 SCD 的风险显著增加，尤其是在进行倾向评分匹配后（OR：1.69，95% CI：1.16-2.45）。我们还发现了一些因素，例如就业状况、穿衣/行走/跑腿困难、一般健康状况、身体健康状况、医疗费用负担能力、心理健康状况以及包括中风、失明、高胆固醇和关节炎在内的合并症与 SCD 显著相关（P 值<0.05）。与创伤后应激障碍和创伤性脑损伤类似，我们的研究表明，在美国，SCD 与与军事相关的活动之间存在因果关系，这对少数族裔群体产生了不成比例的影响。本研究为进一步研究该领域奠定了基础，以便在退伍军人中尽早诊断神经疾病。
