Li Jiaying, Li Junxin
Johns Hopkins University, Baltimore, the United States.
Int J Surg. 2025 Jun 20. doi: 10.1097/JS9.0000000000002628.
The latest global burden of dementia, its risk factors, and demographic and social inequalities remain unclear, yet are crucial for shaping health policies.
We conducted a systematic analysis using data from the 2021 Global Burden of Disease Study to estimate global dementia prevalence, deaths, and disability-adjusted life years (DALYs) for that year and analyzed trends since 1990. We identified regions with similar changes in disease burden patterns, assessed risk factors and their trends, and examined disparities related to sex, age, sociodemographic index (SDI), and universal health coverage (UHC).
In 2021, dementia accounted for 56.9 million global cases, 2.0 million deaths, and 36.3 million DALYs. Global age-standardized rates per 100,000 population were: prevalence 694 (95% uncertainty intervals: 602.9-794.1), deaths 25.2 (6.7-64.2), and DALYs 451 (212.7-950.2), with increases of 3.2%, 0.5%, and 1.2% since 1990, respectively. In 2021, East Asia had the highest regional age-standardized prevalence (887.9), led nationally by China (900.8), Lebanon (828.3), and Germany (820.5). Central Sub-Saharan Africa reported the highest regional age-standardized death rates (34.9), particularly in the Democratic Republic of the Congo and Gabon (35.4 each) and Congo (34.5). For age-standardized DALYs, Central Sub-Saharan Africa was highest regionally (591.4), led by the Democratic Republic of the Congo (600.2), Gabon (588.3), and Afghanistan (577.7). We identified four regional and six national clusters based on prevalence and DALY trends. Women experienced higher prevalence, deaths, and DALYs across all regions and countries. Globally in 2021, high fasting plasma glucose (FPG) (14.6% of age-standardized dementia DALYs, + 39.5% since 1990, leading in 20 regions and 193 countries, impacting males more), high body-mass index (BMI) (7.1%, + 53.3%, leading in 1 region and 11 countries, impacting females more), and smoking (4.1%, - 22.3%, impacting males more) were the main contributors. Across the life course, below the age of 55, high BMI was the main risk for females; below 65, smoking for males; above these ages, high FPG for both sexes. SDI slightly increased DALYs, while UHC significantly reduced them.
Global dementia burden has slightly increased but remains substantial, with significant regional and sex disparities. Poor-performing clusters should adopt strategies from better ones. Prevention programs must target modifiable risk factors-high FPG, BMI, and smoking-using sex- and age-specific approaches. Strengthening UHC is essential to alleviate the growing dementia burden.
痴呆症的最新全球负担、其风险因素以及人口和社会不平等状况仍不明确，但对于制定卫生政策至关重要。
我们利用2021年全球疾病负担研究的数据进行了系统分析，以估计该年全球痴呆症患病率、死亡人数和伤残调整生命年（DALYs），并分析了自1990年以来的趋势。我们确定了疾病负担模式变化相似的地区，评估了风险因素及其趋势，并研究了与性别、年龄、社会人口指数（SDI）和全民健康覆盖（UHC）相关的差异。
2021年，痴呆症在全球范围内导致5690万例病例、200万人死亡和3630万伤残调整生命年。每10万人口的全球年龄标准化率分别为：患病率694（95%不确定区间：602.9 - 794.1）、死亡率25.2（6.7 - 64.2）和伤残调整生命年451（212.7 - 950.2），自1990年以来分别增长了3.2%、0.5%和1.2%。2021年，东亚地区年龄标准化患病率最高（887.9），在国家层面上以中国（900.8）、黎巴嫩（828.3）和德国（820.5）领先。撒哈拉以南非洲中部地区报告的年龄标准化死亡率最高（34.9），特别是在刚果民主共和国和加蓬（均为35.4）以及刚果（34.5）。就年龄标准化伤残调整生命年而言，撒哈拉以南非洲中部地区在区域内最高（591.4），以刚果民主共和国（600.2）、加蓬（588.3）和阿富汗（577.7）领先。我们根据患病率和伤残调整生命年趋势确定了四个区域集群和六个国家集群。在所有地区和国家，女性的患病率、死亡人数和伤残调整生命年都更高。在2021年全球范围内，高空腹血糖（FPG）（占年龄标准化痴呆症伤残调整生命年的14.6%，自1990年以来增加了39.5%，在20个地区和193个国家居首位，对男性影响更大）、高体重指数（BMI）（7.1%，增加53.3%，在1个地区和11个国家居首位，对女性影响更大）和吸烟（4.1%，减少22.3%，对男性影响更大）是主要因素。在整个生命过程中，55岁以下，高BMI是女性的主要风险因素；65岁以下，吸烟是男性的主要风险因素；在这些年龄以上，高空腹血糖对两性都是主要风险因素。社会人口指数使伤残调整生命年略有增加，而全民健康覆盖则显著降低了伤残调整生命年。
全球痴呆症负担略有增加，但仍然很大，存在显著的区域和性别差异。表现较差的集群应采用表现较好集群的策略。预防计划必须针对可改变的风险因素——高空腹血糖、BMI和吸烟——采用针对性别和年龄的方法。加强全民健康覆盖对于减轻不断增加的痴呆症负担至关重要。
