Incidence of Dementia Following Hospitalization With Infection Among Adults in the Atherosclerosis Risk in Communities (ARIC) Study Cohort.
Incidence of Dementia Following Hospitalization With Infection Among Adults in the Atherosclerosis Risk in Communities (ARIC) Study Cohort.
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DOI：
10.1001/jamanetworkopen.2022.50126
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发表时间：
2023-01-03
影响因子：
13.8
通讯作者：
Demmer, Ryan T.
中科院分区：
文献类型：
--
作者：
Bohn, Bruno;Lutsey, Pamela L.;Misialek, Jeffrey R.;Walker, Keenan A.;Brown, Charles H.;Hughes, Timothy M.;Ishigami, Junichi;Matsushita, Kunihiro;Demmer, Ryan T.
感染住院与痴呆发病率相关吗？在社区动脉粥样硬化风险研究中，这项队列研究包括15688名参与者，随访时间超过32年。因感染而住院的参与者患痴呆的可能性是未感染者的1.7倍。这些发现表明，感染与痴呆症的发生有关，预防感染对预防痴呆症可能很重要。本队列研究探讨了社区动脉粥样硬化风险（ARIC）研究参与者因感染住院与痴呆发生率之间的关系。与痴呆风险相关的因素仍有待充分了解。假设全身性感染就是这样的因素，可能是预防和筛查的目标。目的：探讨感染住院与痴呆发生率之间的关系。数据来自社区动脉粥样硬化风险研究（ARIC），这是一项前瞻性队列研究。在美国的4个研究中心进行了登记，于1987年至1989年开始。目前的研究包括截至2019年的32年随访数据。数据分析时间为2021年4月至2022年6月。通过对选定的《国际疾病分类第九次修订版》（ICD-9）和《国际疾病和相关健康问题统计分类第十次修订版》（ICD-10）代码的医疗记录审查，从基线到行政审查或痴呆诊断，确定感染住院情况。参与者在首次感染住院之前被认为未暴露，此后暴露。还考虑了选定的感染亚型。通过监测ICD-9和ICD-10住院和死亡证明代码、面对面评估和电话访谈，确定了事件性痴呆和事件发生时间数据。进行敏感性分析，排除暴露后3年内或20年以上发生的病例。在研究假设制定之前收集数据。在15792名ARIC研究参与者中，选择了15688名基线时无痴呆的黑人或白人参与者作为分析队列（8658名女性[55.2%]；4210名黑人[26.8%]；平均[SD]基线年龄54.7[5.8]岁）。5999名参与者（38.2%）因感染住院。2975名参与者（19.0%）在基线后的中位（IQR）为25.1（22.2-29.1）年被确诊为痴呆。暴露组的痴呆发生率为23.6例/ 1000人年（95% CI, 22.3-25.0例/ 1000人年），未暴露组为5.7例/ 1000人年（95% CI, 5.4-6.0例/ 1000人年）。感染住院患者为2.02例（95% CI, 1.88 ~ 2.18; P < 0.05）。0.001)和1.70 (95% CI, 1.55-1.86; P <。根据未调整和完全调整的Cox比例风险模型，与未暴露的个体相比，0.001)发生偶发性痴呆的可能性高出一倍。当排除从基线开始痴呆少于3年或超过20年或感染事件的个体时，调整后的风险比为5.77 （95% CI, 4.92-6.76; P < .001）。在因呼吸道、泌尿道、皮肤、血液和循环系统或医院获得性感染而住院的患者中，痴呆症的发病率明显更高。年龄和APOE-ε基因型观察到乘法和加性相互作用。在因感染住院治疗的参与者中，观察到痴呆的发生率较高。这些发现支持了感染是痴呆症高风险相关因素的假设。
Are hospitalizations with infection associated with dementia incidence? This cohort study included 15 688 participants over 32 years of follow-up in the Atherosclerosis Risk in Communities study. Participants who were hospitalized with infection were 1.7 times more likely to experience incident dementia compared with those who were unexposed. These findings suggest that infections are associated with incident dementias, and their prevention could be important for dementia prevention. This cohort study examines the association between hospitalization with infection and incident dementia among participants in the Atherosclerosis Risk in Communities (ARIC) study. Factors associated with the risk of dementia remain to be fully understood. Systemic infections are hypothesized to be such factors and may be targets for prevention and screening. To investigate the association between hospitalization with infection and incident dementia. Data from the community-based Atherosclerosis Risk in Communities (ARIC) study, a prospective cohort study, were used. Enrollment occurred at 4 research centers in the US, initiated in 1987 to 1989. The present study includes data up to 2019, for 32 years of follow-up. Data analysis was performed from April 2021 to June 2022. Hospitalizations with infections were identified via medical record review for selected International Classification of Diseases, Ninth Revision (ICD-9) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes, from baseline until administrative censoring or dementia diagnosis. Participants were considered unexposed until first hospitalization with infection and exposed thereafter. Selected infection subtypes were also considered. Incident dementia and time-to-event data were identified through surveillance of ICD-9 and ICD-10 hospitalization and death certificate codes, in-person assessments, and telephone interviews. A sensitivity analysis was conducted excluding cases occurring within 3 years or beyond 20 years from exposure. Data were collected before study hypothesis formulation. Of the 15 792 ARIC study participants, an analytical cohort of 15 688 participants who were dementia free at baseline and of Black or White race were selected (8658 female [55.2%]; 4210 Black [26.8%]; mean [SD] baseline age, 54.7 [5.8] years). Hospitalization with infection occurred among 5999 participants (38.2%). Dementia was ascertained in 2975 participants (19.0%), at a median (IQR) of 25.1 (22.2-29.1) years after baseline. Dementia rates were 23.6 events per 1000 person-years (95% CI, 22.3-25.0 events per 1000 person-years) among the exposed and 5.7 events per 1000 person-years (95% CI, 5.4-6.0 events per 1000 person-years) among the unexposed. Patients hospitalized with infection were 2.02 (95% CI, 1.88-2.18; P < .001) and 1.70 (95% CI, 1.55-1.86; P < .001) times more likely to experience incident dementia according to unadjusted and fully adjusted Cox proportional hazards models compared with individuals who were unexposed. When excluding individuals who developed dementia less than 3 years or more than 20 years from baseline or the infection event, the adjusted hazard ratio was 5.77 (95% CI, 4.92-6.76; P < .001). Rates of dementia were significantly higher among those hospitalized with respiratory, urinary tract, skin, blood and circulatory system, or hospital acquired infections. Multiplicative and additive interactions were observed by age and APOE-ε genotype. Higher rates of dementia were observed among participants who experienced hospitalization with infection. These findings support the hypothesis that infections are factors associated with higher risk of dementias.
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影响因子：
6.3
作者：
Walker KA;Gottesman RF;Wu A;Knopman DS;Mosley TH Jr;Alonso A;Kucharska-Newton A;Brown CH 4th
通讯作者：
Brown CH 4th
影响因子：
5.4
作者：
Cowan, Logan T.;Lutsey, Pamela L.;Lakshminarayan, Kamakshi
通讯作者：
Lakshminarayan, Kamakshi
DOI：
10.3233/jad-200303
发表时间：
2020
期刊：
Journal of Alzheimer's disease : JAD
影响因子：
--
作者：
Muzambi R;Bhaskaran K;Brayne C;Davidson JA;Smeeth L;Warren-Gash C
通讯作者：
Warren-Gash C
影响因子：
24
作者：
Wright JD;Folsom AR;Coresh J;Sharrett AR;Couper D;Wagenknecht LE;Mosley TH Jr;Ballantyne CM;Boerwinkle EA;Rosamond WD;Heiss G
通讯作者：
Heiss G
影响因子：
48
作者：
Barnes, Deborah E.;Yaffe, Kristine
通讯作者：
Yaffe, Kristine