Xiaopeng Zhu, Jing Yu, Xia Lai, Xingsheng Wang, Juan Deng, Yan Long, Baoshan Li
Department of Geriatrics, Chongqing University Central Hospital/Chongqing Emergency Medical Center, Chongqing, China.
Front Public Health. 2025 Jul 1;13:1585711. doi: 10.3389/fpubh.2025.1585711. eCollection 2025.
This study aims to analyze the prevalence, impact, and disparities of Alzheimer's disease and other dementias (ADRD) among adults aged 65 years and older worldwide, across different regions and countries, spanning the years 1991-2021.
GBD 2021 obtained data on dementia from vital registration systems, published scientific literature and surveys, and data from health-service encounters on deaths, excess mortality, prevalence, and incidence from 1991 to 2021, through systematic review and additional data-seeking efforts. Individuals aged ≥65 years from 21 regions and 204 countries and territories (Global Burden of Disease and Risk Factors Study 2021) from 1991 to 2021 were analyzed. Primary outcomes were ADRD related to aged ≥65 years age-standardized prevalence, deaths, disability-adjusted life years (DALYs), and average annual percentage change (AAPC), and the fractions of these metrics that were attributable to three risk factors (high BMI, high fasting glucose, and smoking) that met GBD.
The global mortality of ADRD among adults aged ≥65 years increased by 115%, from 6.5 (95% UI 1.5-18) per 100,000 population in 1991 to 14 (95% UI 3.5-37) per 100,000 population in 2021, with an Average Annual Percentage Change (AAPC) of 1.10% (95%CI 0.45%-1.76%). The prevalence of ADRD in adults aged ≥65 years increased by 160% between 1991 and 2021, from 18.7 (95%UI 14.9-23.2) million to 49 (95%UI 38.6-61.2) million. The aged ≥65 years age-standardized prevalence of ADRD in this age group increased from 11,977 (95%UI 9,438-14,935) per 100,000 population in 1991 to 12,124 (95%UI 9,489-15,204) per 100,000 population in 2021. The aged ≥65 years the number of prevalent persons was more significant among females than among males (males: from 6.2 (95%UI 4.8-7.8) million in 1991 to 17.2 (95%UI 13.4-21.6) million in 2021; women: from 12.5 (95%UI 10.0-15.4) million in 1991 to 31.7 (95%UI 25.1-39.6) million in 2021). In 2021, ADRD in adults aged ≥65 years caused 8.02 (95%UI 1.34-22.19) million deaths and 25.38 (95%UI 23.18-71.20) million DALYs attributable to dementia, and high BMI, high fasting glucose, and smoking remained modifiable risk factors in all risk factors.
From 1991 to 2021, the worldwide prevalence of Alzheimer's disease and other dementias among adults aged 65 and above has increased by 1.6 times, largely driven by the expanding older adults. This escalating trend poses significant challenges to the global healthcare system in terms of both mortality rates and disability-adjusted life years. We recommend that standardized screening programmes be promoted globally, especially in high-risk areas and among high-risk populations, for early detection and intervention of the disease. Secondly, we recommend strengthening the management of risk factor elements.
本研究旨在分析1991年至2021年期间全球65岁及以上成年人中阿尔茨海默病和其他痴呆症（ADRD）的患病率、影响及差异，涵盖不同地区和国家。
全球疾病负担研究（GBD）2021通过系统综述和额外的数据收集工作，从人口动态登记系统、已发表的科学文献和调查以及1991年至2021年期间卫生服务机构关于死亡、超额死亡率、患病率和发病率的数据中获取痴呆症数据。对1991年至2021年来自21个地区和204个国家及地区（全球疾病负担和风险因素研究2021）的65岁及以上个体进行分析。主要结局指标为与65岁及以上年龄标准化患病率、死亡人数、伤残调整生命年（DALYs）以及平均年度百分比变化（AAPC）相关的ADRD，以及这些指标中可归因于符合GBD标准的三个风险因素（高体重指数、高空腹血糖和吸烟）的比例。
1991年至2021年期间，全球65岁及以上成年人中ADRD的死亡率增加了115%，从每10万人6.5（95%不确定区间1.5 - 18）例增至每10万人14（95%不确定区间3.5 - 37）例，平均年度百分比变化（AAPC）为1.10%（95%置信区间0.45% - 1.76%）。1991年至2021年期间，65岁及以上成年人中ADRD的患病率增加了160%，从1870万（95%不确定区间1490万 - 2320万）增至4900万（95%不确定区间3860万 - 6120万）。该年龄组65岁及以上年龄标准化ADRD患病率从1991年的每10万人11977（95%不确定区间9438 - 14935）例增至2021年的每10万人12124（95%不确定区间9489 - 15204）例。65岁及以上的ADRD患病者数量在女性中比男性更显著（男性：从1991年的620万（95%不确定区间480万 - 780万）增至2021年的1720万（95%不确定区间1340万 - 2160万）；女性：从1991年的1250万（95%不确定区间1000万 - 1540万）增至2021年的3170万（95%不确定区间2510万 - 3960万））。2021年，65岁及以上成年人中的ADRD导致802万（95%不确定区间134万 - 2219万）例死亡和2538万（95%不确定区间2318万 - 7120万）例归因于痴呆症的伤残调整生命年，在所有风险因素中，高体重指数、高空腹血糖和吸烟仍是可改变的风险因素。
1991年至2021年期间，全球65岁及以上成年人中阿尔茨海默病和其他痴呆症的患病率增加了1.6倍，主要由老年人口的增加所驱动。这种不断上升的趋势在死亡率和伤残调整生命年方面给全球医疗保健系统带来了重大挑战。我们建议在全球推广标准化筛查项目，特别是在高风险地区和高风险人群中，以便早期发现和干预该疾病。其次，我们建议加强对风险因素的管理。
