美国旧金山退伍军人事务部医疗保健系统Kristine Yaffe团队研究了种族和民族与老年人痴呆症发病率的相关性。2022年4月19日出版的《美国医学会杂志》发表了这一最新研究成果。

美国的种族和民族多样性正在增加，在退伍军人健康管理局（VHA）接受治疗的患者亦是如此。痴呆症是一项重大的公共卫生挑战，在代表性不足的少数族裔和少数民族群体的老年人中发病率可能更高。

为了确定在美国最大的综合医疗保健系统中接受护理的大型、多样化的老年退伍军人全国性队列中，5个族裔和民族群体以及美国地理区域的痴呆症发病率。1999年10月1日至2019年9月30日（最终随访日期），研究组对1869090名55岁及以上的参与者进行了VHA内的回顾性队列研究。

自我报告的种族和民族数据来自国家患者护理数据库。美国地区根据美国疾病控制和预防中心（CDC）地区住宅邮政编码来确定。主要结局是痴呆症的事件诊断（国际疾病分类第9版和第10版）。细灰色比例风险模型用于检查诊断时间，以年龄为时间尺度，并考虑竞争性死亡风险。

1869090名研究参与者的平均年龄为69.4岁，42870名（2%）为女性；6865名为美洲印第安人或阿拉斯加土著（0.4%），9391名为亚裔（0.5%），176795名为黑人（9.5%），20663名为西班牙裔（1.0%），1655376名为白人（88.6%），13%在平均10.1年的随访中被诊断为痴呆症。

美洲印第安人或阿拉斯加土著参与者痴呆症的年龄调整发病率为每1000人-年14.2例，亚裔参与者为12.4例，黑人参与者为19.4例，西班牙裔参与者为20.7例，白人参与者为11.5例。

与白人参与者相比，美洲印第安人或阿拉斯加土著参与者的完全校正危险比为1.05，亚裔参与者为1.20，黑人参与者为1.54，西班牙裔参与者为1.92。在美国大部分地区，黑人和西班牙裔参与者的年龄校正痴呆发病率最高，美洲印第安人或阿拉斯加土著、亚裔和白人参与者的发病率相似。

研究结果表明，在VHA医疗中心接受治疗的老年人中，基于种族和民族的痴呆症发病率存在显著差异。仍需进一步的研究来理解造成这些差异的机制。

附：英文原文

Title: Association of Race and Ethnicity With Incidence of Dementia Among Older Adults

Author: Erica Kornblith, Amber Bahorik, W. John Boscardin, Feng Xia, Deborah E. Barnes, Kristine Yaffe

Issue&Volume: 2022/04/19

Abstract:

Importance  The racial and ethnic diversity of the US, including among patients receiving their care at the Veterans Health Administration (VHA), is increasing. Dementia is a significant public health challenge and may have greater incidence among older adults from underrepresented racial and ethnic minority groups.

Objective  To determine dementia incidence across 5 racial and ethnic groups and by US geographical region within a large, diverse, national cohort of older veterans who received care in the largest integrated health care system in the US.

Design, Setting, and Participants  Retrospective cohort study within the VHA of a random sample (5% sample selected for each fiscal year) of 1869090 participants aged 55 years or older evaluated from October 1, 1999, to September 30, 2019 (the date of final follow-up).

Exposures  Self-reported racial and ethnic data were obtained from the National Patient Care Database. US region was determined using Centers for Disease Control and Prevention (CDC) regions from residential zip codes.

Main Outcomes and Measures  Incident diagnosis of dementia (9th and 10th editions of the International Classification of Diseases). Fine-Gray proportional hazards models were used to examine time to diagnosis, with age as the time scale and accounting for competing risk of death.

Results  Among the 1869090 study participants (mean age, 69.4 [SD, 7.9] years; 42870 women [2%]; 6865 American Indian or Alaska Native [0.4%], 9391 Asian [0.5%], 176795 Black [9.5%], 20663 Hispanic [1.0%], and 1655376 White [88.6%]), 13% received a diagnosis of dementia over a mean follow-up of 10.1 years. Age-adjusted incidence of dementia per 1000 person-years was 14.2 (95% CI, 13.3-15.1) for American Indian or Alaska Native participants, 12.4 (95% CI, 11.7-13.1) for Asian participants, 19.4 (95% CI, 19.2-19.6) for Black participants, 20.7 (95% CI, 20.1-21.3) for Hispanic participants, and 11.5 (95% CI, 11.4-11.6) for White participants. Compared with White participants, the fully adjusted hazard ratios were 1.05 (95% CI, 0.98-1.13) for American Indian or Alaska Native participants, 1.20 (95% CI, 1.13-1.28) for Asian participants, 1.54 (95% CI, 1.51-1.57) for Black participants, and 1.92 (95% CI, 1.82-2.02) for Hispanic participants. Across most US regions, age-adjusted dementia incidence rates were highest for Black and Hispanic participants, with rates similar among American Indian or Alaska Native, Asian, and White participants.

Conclusions and Relevance  Among older adults who received care at VHA medical centers, there were significant differences in dementia incidence based on race and ethnicity. Further research is needed to understand the mechanisms responsible for these differences.

DOI: 10.1001/jama.2022.3550

Source: https://jamanetwork.com/journals/jama/article-abstract/2791223