Population attributable fractions for risk factors for dementia in low-income and middle-income countries: an analysis using cross-sectional survey data
Population attributable fractions for risk factors for dementia in low-income and middle-income countries: an analysis using cross-sectional survey data
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DOI：
10.1016/s2214-109x(19)30074-9
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发表时间：
2019-05-01
影响因子：
34.3
通讯作者：
Livingston, Gill
中科院分区：
文献类型：
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作者：
Mukadam, Naaheed;Sommerlad, Andrew;Livingston, Gill
九个潜在的可改变的风险因素（儿童教育程度低，中年听力损失，高血压和肥胖，以及晚年吸烟，抑郁，身体活动不足，社会孤立和糖尿病）占全球痴呆症的35%，但大多数计算这些风险因素的数据仅来自高收入国家。我们的目的是计算选定的低收入和中等收入国家（LMICs）中痴呆症的人口归因分数（PAF），以确定这些国家潜在的痴呆症预防目标。方法本研究分析了来自印度，中国和六个拉丁美洲国家代表性人群的10/66痴呆症研究调查的横断面数据（古巴、多米尼加共和国、墨西哥、秘鲁、波多黎各和委内瑞拉），这些国家在每个国家使用相同的风险因素确定方法。在2004年至2006年期间（波多黎各在2007年至2010年期间），所有65岁及以上的居民在预定的集水区被邀请参加调查。我们使用来自10/66调查数据的风险因素患病率估计值和来自先前荟萃分析的相对风险估计值来计算每个风险因素的PAF。为了解释具有重叠危险因素的个体，我们调整了危险因素之间的公共性PAF，并使用这些值来计算印度，中国和拉丁美洲样本的总体加权PAF。（95% CI 37.5-41.6），印度（n =2004）为41.2%（39.1-43.4），拉丁美洲样本（n=12865）为55.8%（54.9-56.7）。五个痴呆症风险因素在这些LMIC中比全球估计更普遍，导致痴呆症的PAF更高：童年教育较少（中国的加权PAF为10.8%，印度为13.6%，拉丁美洲为10.9%，全球为7.5%），吸烟（分别为14.7%、6.4%和5.7%，全球为5.5%），高血压（6.4%、4.0%和9.3%，vs 2.0%），肥胖（5.6%、2.9%和7.9%，vs 0.8%）和糖尿病（1.6%、1.7%和3.2%，对比1.2%）.解读印度、中国和拉美国家这一样本的痴呆症预防潜力大而且比高收入国家更高。早期教育程度低、高血压、听力损失、肥胖和缺乏身体活动的PAF特别高，可能是痴呆症预防策略的最初目标。版权所有（C）2019作者。出版社：Elsevier Ltd
Background Nine potentially modifiable risk factors (less childhood education, midlife hearing loss, hypertension, and obesity, and later-life smoking, depression, physical inactivity, social isolation, and diabetes) account for 35% of worldwide dementia, but most data to calculate these risk factors come from high-income countries only. We aimed to calculate population attributable fractions (PAFs) for dementia in selected low-income and middle-income countries (LMICs) to identify potential dementia prevention targets in these countries.Methods The study was an analysis of cross-sectional data obtained from the 10/66 Dementia Research surveys of representative populations in India, China, and six Latin America countries (Cuba, Dominican Republic, Mexico, Peru, Puerto Rico, and Venezuela), which used identical risk factor ascertainment methods in each country. Between 2004 and 2006 (and between 2007 and 2010 for Puerto Rico), all residents aged 65 years and older in predefined catchment areas were invited to participate in the survey. We used risk factor prevalence estimates from this 10/66 survey data, and relative risk estimates from previous meta-analyses, to calculate PAFs for each risk factor. To account for individuals having overlapping risk factors, we adjusted PAF for communality between risk factors, and used these values to calculate overall weighted PAFs for India, China, and the Latin American sample.Findings The overall weighted PAF for potentially modifiable risk factors for dementia was 39.5% (95% CI 37.5-41.6) in China (n=2162 participants), 41.2% (39.1-43.4) in India (n=2004), and 55.8% (54.9-56.7) in our Latin American sample (n=12865). Five dementia risk factors were more prevalent in these LMICs than worldwide estimates, leading to higher PAFs for dementia: less childhood education (weighted PAF of 10.8% in China, 13.6% in India, and 10.9% in Latin America vs 7.5% worldwide), smoking (14.7%, 6.4%, and 5.7%, respectively, vs 5.5% worldwide), hypertension (6.4%, 4.0%, and 9.3%, vs 2.0%), obesity (5.6%, 2.9%, and 7.9%, vs 0.8%), and diabetes (1.6%, 1.7%, and 3.2%, vs 1.2%).Interpretation The dementia prevention potential in India, China, and this sample of Latin American countries is large, and greater than in high-income countries. Less education in early life, hypertension, hearing loss, obesity, and physical inactivity have particularly high PAFs and could be initial targets for dementia prevention strategies. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.