Asta Federica, Bellomo Guido, Contoli Benedetta, Lombardo Flavia L, Minardi Valentina, Salemme Simone, Vanacore Nicola, Masocco Maria
National Center for Disease Prevention and Health Promotion, Italian National Institute of Health Rome, Italy.
National Center for Disease Prevention and Health Promotion, Italian National Institute of Health Rome, Italy.
J Prev Alzheimers Dis. 2025 Jan 13:100055. doi: 10.1016/j.tjpad.2024.100055.
Dementia is a major global public health challenge, with over 50 million cases in 2020, projected to reach 152 million by 2050. Effective prevention strategies are needed to reduce the impact of modifiable risk factors associated with dementia, particularly in countries with ageing populations like Italy. The Population Attributable Fraction (PAF) and Potential Impact Fraction (PIF) are key metrics for understanding and reducing dementia cases through targeted interventions.
This study aimed to revise and expand PAF estimates for dementia in Italy, integrate them with PIF calculations, and assess the alignment of regional health policies with these risk factors. Additionally, the study explored regional variations in PAFs and evaluated the potential for reducing dementia incidence through feasible public health interventions.
A cross-sectional analysis was conducted using data from two national public health surveillance systems, PASSI and PASSI d'Argento (PdA), to estimate PAFs and PIFs for dementia at both national and regional levels. The study used data collected between 2017 and 2019.
Data were drawn from 19 Italian regions and two autonomous provinces, providing national and subnational estimates of modifiable risk factors for dementia.
The study population included a nationally representative sample of 86,494 individuals aged 18-64 (PASSI) and 48,516 individuals aged 65 and older (PdA).
PAFs were calculated for 11 of the 12 modifiable risk factors identified by the Lancet Commission in 2021, with data from the PASSI and PdA systems. PIFs were calculated to estimate the potential reduction in dementia cases under different intervention scenarios. Regional variations in PAFs were assessed and aligned with health policies outlined in the Regional Prevention Plans.
The national combined PAF for 11 modifiable risk factors was 39.6 % (95 % CI: 20.8-55.9). Midlife hypertension and physical inactivity were the most significant contributors, accounting for 12.3 % of the total PAF. Cardiovascular risk factors collectively explained over 50 % of preventable dementia cases. Regional PAFs ranged from 31.7 % to 47.5 %, with a clear north-south gradient; southern regions exhibited higher PAFs due to cardiovascular factors. Despite broad consistency between national and regional PAFs, significant variability was found in how regions addressed risk factors, particularly air pollution. At the national level, a 10 % reduction in risk factors would prevent 54,495 dementia cases, with subnational PIFs ranging from 3.7 % to 6.0 %.
This study highlights the substantial potential for dementia prevention in Italy through targeted public health interventions. However, significant regional disparities in PAFs and the alignment of health policies underscore the need for a more nuanced, regionally tailored approach. Future strategies should integrate both PAF and PIF to maximize the impact of interventions, particularly in addressing cardiovascular risk factors. These findings can guide the development of evidence-based policies to reduce dementia incidence across Italy.
痴呆症是一项重大的全球公共卫生挑战，2020年全球病例超过5000万例，预计到2050年将达到1.52亿例。需要有效的预防策略来减少与痴呆症相关的可改变风险因素的影响，尤其是在意大利等人口老龄化的国家。人群归因分数（PAF）和潜在影响分数（PIF）是通过有针对性的干预措施来理解和减少痴呆症病例的关键指标。
本研究旨在修订和扩展意大利痴呆症的PAF估计值，将其与PIF计算相结合，并评估区域卫生政策与这些风险因素的一致性。此外，该研究还探讨了PAF的区域差异，并评估了通过可行的公共卫生干预措施降低痴呆症发病率的潜力。
采用来自两个国家公共卫生监测系统PASSI和PASSI d'Argento（PdA）的数据进行横断面分析，以估计国家和区域层面痴呆症的PAF和PIF。该研究使用了2017年至2019年期间收集的数据。
数据来自意大利的19个地区和两个自治省，提供了全国和次国家层面可改变的痴呆症风险因素估计值。
研究人群包括具有全国代表性的86494名18至64岁个体（PASSI）和48516名65岁及以上个体（PdA）。
根据《柳叶刀》委员会在2021年确定的12个可改变风险因素中的11个，利用PASSI和PdA系统的数据计算PAF。计算PIF以估计不同干预情景下痴呆症病例的潜在减少量。评估PAF的区域差异，并使其与区域预防计划中概述的卫生政策保持一致。
11个可改变风险因素的全国综合PAF为39.6%（95%CI：20.8-55.9）。中年高血压和身体活动不足是最主要的因素，占总PAF的12.3%。心血管风险因素共同解释了超过50%的可预防痴呆症病例。区域PAF范围为31.7%至47.5%，呈现明显的南北梯度；由于心血管因素，南部地区的PAF较高。尽管国家和区域PAF之间总体一致，但在各地区应对风险因素的方式上发现了显著差异，尤其是空气污染方面。在国家层面，风险因素降低10%将预防54495例痴呆症病例，次国家层面的PIF范围为3.7%至6.0%。
本研究强调了通过有针对性的公共卫生干预措施在意大利预防痴呆症的巨大潜力。然而，PAF的显著区域差异以及卫生政策的一致性凸显了需要采取更细致、因地制宜的方法。未来的策略应将PAF和PIF结合起来，以最大限度地提高干预措施的效果，特别是在应对心血管风险因素方面。这些发现可为制定基于证据的政策提供指导，以降低意大利全国的痴呆症发病率。
