The rising burden of Alzheimer's disease mortality in rural America.
The rising burden of Alzheimer's disease mortality in rural America.
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DOI：
10.1016/j.ssmph.2022.101052
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Franco Y
中科院分区：
文献类型：
--
作者：
Ho JY;Franco Y
自20世纪90年代以来，美国的预期寿命出现了惊人的城乡差异，大都市地区的预期寿命大幅增长，而非大都市地区的预期寿命则停滞不前或实际下降。虽然阿尔茨海默病和相关痴呆症（ADRD）可能会在非大都市地区构成特殊的挑战，但我们对非大都市地区ADRD死亡率的水平，它如何随时间变化以及它是否有助于大都市/非大都市预期寿命差距知之甚少。这项研究发现，在1999年至2019年期间，非大都市地区的ADRD死亡率比所有其他大都市地区（大型中央都市，郊区和中小城市）上升得更快。虽然1999年大型中央地铁和非地铁的ADRD死亡率几乎相同，但在过去二十年中出现了明显的地铁/非地铁梯度并大幅扩大。今天，非地铁现在经历ADRD死亡率最高的水平，而大型中心城市的水平最低。这些城市/非城市的ADRD差距因区域而异，在大西洋中部和南大西洋观察到的差距最大。在许多地区，ADRD对65岁时的预期寿命的都市/非都市差异的贡献相当大，妇女高达30%，男子高达13%。在一些地区，ADRD对女性预期寿命差距的贡献与心脏病，癌症和慢性下呼吸道疾病等其他主要死亡原因的贡献相当或超过。阿尔茨海默氏病死亡率的上升负担可能对美国农村地区构成重大挑战，这些地区正在迅速老龄化，经历不利的死亡率趋势，并且在社会经济资源和医疗保健基础设施方面日益处于不利地位。1999年至2019年期间，ADRD死亡率在非大都市地区增加最多。今天，非大都市地区的ADRD死亡率最高。大型中心城市和非城市之间ADRD死亡率的差距已经扩大。不同地区ADRD死亡率的城市/非城市差距差异很大。在某些地区，农业和农村发展是造成城乡预期寿命差距的主要因素。
Since the 1990s, there has been a striking urban-rural divergence in life expectancy within the United States, with metropolitan areas achieving strong life expectancy increases and nonmetropolitan areas experiencing stagnation or actual declines in life expectancy. While Alzheimer's disease and related dementias (ADRD) are likely to pose a particular challenge in nonmetropolitan areas, we know relatively little about the level of ADRD mortality in nonmetropolitan areas, how it has changed over time, and whether it is contributing to metropolitan/nonmetropolitan life expectancy gaps. This study finds that ADRD mortality has risen more rapidly in nonmetropolitan areas than in all other metro areas (large central metros, suburbs, and medium/small cities) between 1999 and 2019. While death rates from ADRD were nearly identical in large central metros and nonmetros in 1999, a clear metro/nonmetro gradient has emerged and widened substantially over the past two decades. Today, nonmetros now experience the highest levels of ADRD mortality, while large central metros have the lowest levels. These metro/nonmetro gaps in ADRD differ substantially by region, with the largest gaps observed in the Middle Atlantic and South Atlantic. The contribution of ADRD to metro/nonmetro differences life expectancy at age 65 is now considerable in many regions, reaching up to 30% for women and 13% for men. In several regions, ADRD's contribution to female life expectancy gaps is on par with or exceeds the contributions of other leading causes of death such as heart disease, cancer, and chronic lower respiratory diseases. The rising burden of Alzheimer's disease mortality is likely to pose a substantial challenge in rural areas of the United States which are aging rapidly, experiencing adverse mortality trends, and increasingly disadvantaged in terms of socioeconomic resources and health care infrastructure. ADRD mortality increased the most in nonmetropolitan areas between 1999 and 2019. Today, nonmetropolitan areas have the highest levels of ADRD mortality. Gaps in ADRD mortality between large central metros and nonmetros have widened. Metro/nonmetro gaps in ADRD mortality differ substantially by region. In some areas, ADRD is the leading contributor to urban/rural life expectancy gaps.
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影响因子：
9.9
作者：
James, Bryan D.;Leurgans, Sue E.;Bennett, David A.
通讯作者：
Bennett, David A.
影响因子：
2.5
作者：
Elo, Irma T.;Hendi, Arun S.;Preston, Samuel H.
通讯作者：
Preston, Samuel H.
影响因子：
3.5
作者：
Hendi, Arun S.
通讯作者：
Hendi, Arun S.
影响因子：
7.7
作者：
Hendi, Arun S.
通讯作者：
Hendi, Arun S.
DOI：
10.1136/bmj.k2562
发表时间：
2018-08-15
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Ho JY;Hendi AS
通讯作者：
Hendi AS