Sex Differences in the Risk of Dementia in Older Veterans
Sex Differences in the Risk of Dementia in Older Veterans
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DOI：
10.1093/gerona/glac029
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发表时间：
2022-02-03
影响因子：
5.1
通讯作者：
Yaffe, Kristine
中科院分区：
文献类型：
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作者：
Eastman, Jennifer;Bahorik, Amber;Yaffe, Kristine
背景研究表明，与男性相比，女性患痴呆症的患病率更高。然而，痴呆症发病率的性别差异存在争议，相互矛盾的报告显示女性的痴呆症发病率较高、较低或相似。差异的来源可能是由于临床环境和缺乏对死亡竞争风险的考虑。我们检查了全国退伍军人群体样本中的痴呆症发病率，以确定性别差异。方法 我们检查了来自美国最大的综合医疗保健系统退伍军人健康管理局 (VHA) 的数据。我们研究了 1999 年 10 月 1 日至 2019 年 9 月 30 日在 VHA 中评估的 947 797 名年龄 >= 55 岁的退伍军人（平均年龄：69.9 +/- 8.4，3% 为女性）。我们按性别估计了痴呆症的年龄调整发病率（国际疾病分类，第 9 版和第 10 版代码），并使用以年龄为时间尺度的细灰色比例风险模型检查诊断时间，考虑死亡的竞争风险。结果 在随访期间（平均 8.4 年），11.3%（n = 106 977 人，11.4% 男性和 8.0% 女性）的退伍军人患上了痴呆症。男性的年龄调整发病率为 12.6/1 000 人年，女性为 12.7/1 000 人年。与男性退伍军人相比，女性退伍军人患痴呆症的风险略高（风险比 = 1.15；95% 置信区间：1.10-1.20），平均而言，女性退伍军人患痴呆症的时间比男性退伍军人早 0.2 年。在对种族、教育、医疗和精神状况进行额外调整后，结果相似。结论 在全国队列中的老年退伍军人中，考虑到竞争性死亡风险后，女性患痴呆症的风险比男性略有增加。
Background Studies have demonstrated women to have a higher prevalence of dementia compared to men. However, sex differences in dementia incidence are controversial with conflicting reports showing women with higher, lower, or similar incidence. Source of difference may be due to clinical setting and lack of consideration of competing risk of death. We examined dementia incidence in a sample of the national Veteran population to determine differences by sex. Methods We examined data from the Veterans Health Administration (VHA), the largest integrated health care system in the United States. We studied 947 797 Veterans aged >= 55 years (mean age: 69.9 +/- 8.4, 3% female) evaluated in the VHA from October 1, 1999 to September 30, 2019. We estimated age-adjusted incidence rates of dementia (International Classification of Diseases, 9th and 10th Edition codes) by sex, and used Fine-Gray proportional hazards models with age as time scale to examine time to diagnosis, accounting for competing risk of death. Results During the follow-up (mean 8.4 years), 11.3% (n = 106 977, 11.4% men and 8.0% women) of Veterans developed dementia. Age-adjusted incidence was 12.6/1 000 person-years for men and 12.7/1 000 person-years for women. Compared to male Veterans, risk dementia was slightly higher among females (hazard ratio = 1.15; 95% confidence interval: 1.10-1.20), and on average, female Veterans developed dementia 0.2 years earlier than male Veterans. After additional adjustment for race, education, medical, and psychiatric conditions, results were similar. Conclusions Among older Veterans in a national cohort, women had a slightly increased risk for developing dementia compared to men after accounting for competing risk of death.