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基于夏威夷医疗保险数据的阿尔茨海默病患者心血管疾病风险及种族/民族差异

Cardio and cerebrovascular diseases risk among Alzheimer's disease patients and racial/ethnic disparities, based on Hawaii Medicare data.

作者信息

Siriwardhana Chathura, Carrazana Enrique, Liow Kore, Chen John J

机构信息

Department of Quantitative Health Sciences, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA.

Department of Medicine, University of Hawaii John Burns School of Medicine, Honolulu, HI, USA.

出版信息

J Alzheimers Dis Rep. 2024 Nov 24;8(1):1529-1540. doi: 10.1177/25424823241289038. eCollection 2024.

Abstract

BACKGROUND

Alzheimer's disease (AD) and cardiovascular and cerebrovascular diseases (CVD) are significant concerns among the elderly, sharing overlapping risk factors. Hawaii's unique demographic profile, characterized by its strong ethnic diversity, shows marked racial health disparities. For instance, the Native Hawaiian/Pacific Islander (NHPI) population is identified as a high-risk group for multiple health conditions, including CVD.

OBJECTIVE

This study investigates the impact of AD on the risk of developing CVD, with a focus on racial influences, utilizing Hawaii Medicare data.

METHODS

Employing nine years of longitudinal Hawaii Medicare data, this study identified elderly patients diagnosed with AD who subsequently developed heart failure (HF), ischemic heart disease (IHD), atrial fibrillation (AF), acute myocardial infarction (AMI), or stroke. To assess the risk of CVD, we utilized multistate models and employed propensity score-matched controls. Additionally, we evaluated racial and ethnic differences in the risk of these diseases, while accounting for other relevant risk factors.

RESULTS

Our findings revealed an elevated risk of AMI, HF, and IHD among individuals diagnosed with AD. Additionally, socioeconomic status (SE) was identified as a crucial factor in the risk of cardio and cerebrovascular diseases. Within the low SE group, NHPIs exhibited increased risks of HF and IHD compared to their white counterparts. Interestingly, NHPIs demonstrated reduced risks of HF in the higher SE group.

CONCLUSIONS

The presence of AD increases the likelihood of developing AMI, HF, and IHD. Moreover, the risk of CVD appears to be influenced by race/ethnicity in Hawaii, as well as socioeconomic status.

摘要

背景

阿尔茨海默病(AD)与心脑血管疾病(CVD)是老年人面临的重大问题,二者存在重叠的风险因素。夏威夷独特的人口结构以其强烈的种族多样性为特征,呈现出显著的种族健康差异。例如,夏威夷原住民/太平洋岛民(NHPI)群体被确定为包括CVD在内的多种健康状况的高危人群。

目的

本研究利用夏威夷医疗保险数据,调查AD对发生CVD风险的影响,重点关注种族影响。

方法

本研究采用了九年的夏威夷医疗保险纵向数据,确定了被诊断患有AD且随后发展为心力衰竭(HF)、缺血性心脏病(IHD)、心房颤动(AF)、急性心肌梗死(AMI)或中风的老年患者。为了评估CVD风险,我们使用了多状态模型并采用倾向得分匹配对照。此外,我们评估了这些疾病风险中的种族和民族差异,同时考虑了其他相关风险因素。

结果

我们的研究结果显示,被诊断患有AD的个体发生AMI、HF和IHD的风险升高。此外,社会经济地位(SE)被确定为心脑血管疾病风险的一个关键因素。在低SE组中,与白人相比,NHPI发生HF和IHD的风险增加。有趣的是,在高SE组中,NHPI发生HF的风险降低。

结论

AD的存在增加了发生AMI、HF和IHD的可能性。此外,在夏威夷,CVD风险似乎受到种族/民族以及社会经济地位的影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a34f/11864236/212243ed8f8e/10.1177_25424823241289038-fig1.jpg

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