社会经济地位与健康生活方式与新发痴呆症及认知衰退的关联：两项前瞻性队列研究。
Associations of socioeconomic status and healthy lifestyle with incident dementia and cognitive decline: two prospective cohort studies.
作者信息
Wang Kan, Fang Yuan, Zheng Ruizhi, Zhao Xuan, Wang Siyu, Lu Jieli, Wang Weiqing, Ning Guang, Xu Yu, Bi Yufang
机构信息
Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
National Clinical Research Center for Metabolic Diseases (Shanghai), Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission, National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
出版信息
EClinicalMedicine. 2024 Sep 16;76:102831. doi: 10.1016/j.eclinm.2024.102831. eCollection 2024 Oct.
BACKGROUND
Little is known about the complex associations of socioeconomic status (SES) and healthy lifestyle with cognitive dysfunction.
METHODS
Using data from the Health and Retirement Study (HRS) [2008-2020] and the English Longitudinal Study of Ageing (ELSA) [2004-2018], SES was constructed by latent class analysis using education level, total household income and wealth. Overall healthy lifestyle was derived using information on never smoking, low to moderate alcohol consumption (drinks/day: (0, 1] for women and (0, 2] for men), top tertile of physical activity, and active social contact.
FINDINGS
A total of 12,437 and 6565 participants from the HRS and ELSA were included (40.8% and 46.0% men and mean age 69.3 years and 65.1 years, respectively). Compared with participants of high SES, those of low SES had higher risk of incident dementia (hazard ratio 3.17, 95% confidence interval 2.72-3.69 in the HRS; 1.43, 1.09-1.86 in the ELSA), and the proportions mediated by overall lifestyle were 10.4% (7.3%-14.6%) and 2.7% (0.5%-14.0%), respectively. Compared with participants of high SES and favorable lifestyle, those with low SES and unfavorable lifestyle had a higher risk of incident dementia (4.27, 3.40-5.38 in the HRS; 2.02, 1.25-3.27 in the ELSA) and accelerated rate of global cognitive decline ( = -0.058 SD/year; 95% CI: -0.073, -0.043 in the HRS; = -0.049 SD/year; 95% CI: -0.063, -0.035 in the ELSA).
INTERPRETATION
Unhealthy lifestyle only mediated a small proportion of the socioeconomic inequality in dementia risk in both US and UK older adults.
FUNDING
This work was supported by grants from the National Natural Science Foundation of China (82088102 and 82370819), the National Key R&D Program of China (2023YFC2506700), the Shanghai Municipal Government (22Y31900300), the Shanghai Clinical Research Center for Metabolic Diseases (19MC1910100), the Innovative Research Team of High-Level Local Universities in Shanghai, the Special Project for Clinical Research in Health Industry of Shanghai Municipal Health Commission (202340084), and Ruijin Hospital Youth Incubation Project (KY20240805). Y.X. is supported by the National Top Young Talents program.
背景
社会经济地位（SES）和健康生活方式与认知功能障碍之间的复杂关联鲜为人知。
方法
利用健康与退休研究（HRS）[2008 - 2020年]和英国老龄化纵向研究（ELSA）[2004 - 2018年]的数据，通过潜在类别分析，利用教育水平、家庭总收入和财富构建社会经济地位。总体健康生活方式通过从不吸烟、低至中度饮酒（女性每天饮酒量：(0, 1]，男性每天饮酒量：(0, 2]）、体力活动处于最高三分位数以及积极的社交接触等信息得出。
研究结果
HRS和ELSA分别纳入了12437名和6565名参与者（男性分别占40.8%和46.0%，平均年龄分别为69.3岁和65.1岁）。与高社会经济地位的参与者相比，低社会经济地位的参与者患痴呆症的风险更高（HRS中风险比为3.17，95%置信区间为2.72 - 3.69；ELSA中为1.43，1.09 - 1.86），总体生活方式介导的比例分别为10.4%（7.3% - 14.6%）和2.7%（0.5% - 14.0%）。与高社会经济地位且生活方式良好的参与者相比，低社会经济地位且生活方式不良的参与者患痴呆症的风险更高（HRS中为4.27，3.40 - 5.38；ELSA中为2.02，1.25 - 3.27），且全球认知衰退速度加快（HRS中为 - 0.058标准差/年；95%置信区间： - 0.073， - 0.043；ELSA中为 - 0.049标准差/年；95%置信区间： - 0.063， - 0.035）。
解读
在美国和英国的老年人中，不健康的生活方式仅介导了痴呆症风险社会经济不平等的一小部分。
资金支持
本研究得到了中国国家自然科学基金（82088102和82370819）、中国国家重点研发计划（2023YFC2506700）、上海市政府（22Y31900300）、上海市代谢性疾病临床研究中心（19MC1910100）、上海市高水平地方高校创新研究团队、上海市卫生健康委员会卫生行业临床研究专项（202340084）以及瑞金医院青年孵化项目（KY20240805）的资助。Y.X.得到了国家高层次青年人才计划的支持。
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