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美国痴呆症的病程及终生风险不平等情况。

Inequalities in the Duration and Lifetime Risk of Dementia in the United States.

作者信息

Hudomiet Péter, Hurd Michael D, Rohwedder Susann

机构信息

RAND, Santa Monica, CA, USA.

RAND, Santa Monica, CA, USA; National Bureau of Economic Research, Cambridge, MA, USA; Netspar, Tilburg, the Netherlands.

出版信息

Demography. 2025 Aug 1;62(4):1389-1412. doi: 10.1215/00703370-12175489.


DOI:10.1215/00703370-12175489
PMID:40739976
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12370282/
Abstract

Dementia prevalence exceeds 40% for individuals in advanced old age, but that figure is not informative about the lifetime risk of ever having dementia or the risk of having dementia for different durations. This study presents U.S. nationally representative estimates of the probability of having dementia for at least six months or one, two, or five years before death and variation in this probability by sex, race and ethnicity, health, and socioeconomic status. We used a joint longitudinal latent variable model of cognitive status, dementia, and survival to derive estimates based on data from the Health and Retirement Study. We found a higher lifetime risk of dementia than found in earlier U.S. studies: 41.3% (CI: 39.3% to 43.2%) of those who died after age 70 had dementia assessed at six months before death. Further, 38.7% (CI: 36.8% to 40.5%), 33.6% (CI: 31.8% to 35.4%), and 20.1% (CI: 18.6% to 21.5%) had dementia one, two, and five years before death, respectively. The risk was higher for women, individuals with less education, non-Hispanic Black individuals, and those with lower lifetime earnings. Having had a stroke significantly increased the risk of dementia. Even though longevity is the strongest known risk factor, longer lived subpopulations have a lower lifetime risk of dementia as a result of their lower age-specific prevalence.

摘要

高龄个体的痴呆症患病率超过40%,但该数字并未提供有关患痴呆症的终生风险或不同时长患痴呆症风险的信息。本研究给出了美国具有全国代表性的估计数据,涉及在死亡前至少六个月、一年、两年或五年患痴呆症的概率,以及该概率在性别、种族和族裔、健康状况和社会经济地位方面的差异。我们使用了一个关于认知状态、痴呆症和生存情况的联合纵向潜变量模型,根据健康与退休研究的数据得出估计值。我们发现,痴呆症的终生风险高于美国早期研究的结果:在70岁以后死亡的人群中,41.3%(置信区间:39.3%至43.2%)在死亡前六个月被评估为患有痴呆症。此外,分别有38.7%(置信区间:36.8%至40.5%)、33.6%(置信区间:31.8%至35.4%)和20.1%(置信区间:18.6%至21.5%)在死亡前一年、两年和五年患有痴呆症。女性、受教育程度较低的个体、非西班牙裔黑人个体以及终生收入较低的个体患痴呆症的风险更高。曾患中风会显著增加患痴呆症的风险。尽管长寿是已知最强的风险因素,但由于特定年龄患病率较低,长寿亚人群的痴呆症终生风险较低。

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本文引用的文献

[1]
Cohort Differences in Physical Health and Disability in the United States and Europe.

J Gerontol B Psychol Sci Soc Sci. 2024-8-1

[2]
The importance of education for understanding variability of dementia onset in the United States.

Demogr Res. 2024

[3]
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Alzheimers Dement. 2024-5

[4]
Using Age-Specific Rates for Parametric Survival Function Estimation in Simulation Models.

Med Decis Making. 2024-5

[5]
Mapping racial and ethnic healthcare disparities for persons living with dementia: A scoping review.

Alzheimers Dement. 2024-4

[6]
The worldwide costs of dementia in 2019.

Alzheimers Dement. 2023-7

[7]
Apoe4 and Alzheimer's Disease Pathogenesis-Mitochondrial Deregulation and Targeted Therapeutic Strategies.

Int J Mol Sci. 2023-1-1

[8]
Could Country-Level Factors Explain Sex Differences in Dementia Incidence and Prevalence? A Systematic Review and Meta-Analysis.

J Alzheimers Dis. 2023

[9]
Trends in inequalities in the prevalence of dementia in the United States.

Proc Natl Acad Sci U S A. 2022-11-16

[10]
Variation in Population Attributable Fraction of Dementia Associated With Potentially Modifiable Risk Factors by Race and Ethnicity in the US.

JAMA Netw Open. 2022-7-1

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