Temporal trend in dementia incidence since 2002 and projections for prevalence in England and Wales to 2040: modelling study.
Temporal trend in dementia incidence since 2002 and projections for prevalence in England and Wales to 2040: modelling study.
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DOI：
10.1136/bmj.j2856
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发表时间：
2017-07-05
期刊：
影响因子：
--
通讯作者：
Brunner EJ
中科院分区：
文献类型：
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作者：
Ahmadi-Abhari S;Guzman-Castillo M;Bandosz P;Shipley MJ;Muniz-Terrera G;Singh-Manoux A;Kivimäki M;Steptoe A;Capewell S;O'Flaherty M;Brunner EJ
目的用一种动态建模方法预测痴呆症患病率，该方法将痴呆症发病率的日历趋势与死亡率和心血管疾病的趋势相结合。设计与造型研究。背景是英格兰和威尔士的一般成年人口。英国老龄化纵向研究(ELSA)的参与者是一项具有代表性的小组研究，包含2002-13年间的六波数据。随机挑选的50岁或50岁以上的男性和女性及其同居伴侣被招募到第一波ELSA(2002-03)。11392名成人参与(应答率为67%)。为了保持代表性，在随后的WAVE中，茶点参与者被招募到研究中。分析样本总数为17个 906人。以认知和功能损害为基础的恒定客观标准被用来确定每个波的痴呆病例。主要观察指标：为了估计痴呆症发病率的日历趋势，纠正因研究参与者失去随访而造成的偏差，将纵向数据和事件发生时间数据的联合模型与ELSA数据进行拟合。为了预测未来痴呆的患病率，开发了概率马尔可夫模型IMPACT-BAM(Impact-Better Ageing Model)。Impact-BAM模拟35岁或35岁以上人群从心血管疾病、认知和功能障碍以及痴呆症到死亡的转变。它能够预测痴呆症的患病率，同时考虑到由于预期寿命延长以及死亡率和心血管疾病发病率变化造成的竞争影响而导致的易感人群不断增加的情况。结果在埃尔萨，2010年男性痴呆症发病率估计为14.3/1000人年，50岁或以上女性为17.0/1000人年。在2002-13年间，痴呆症发病率以每年2.7%(95%可信区间2.4%至2.9%)的相对速度下降。使用Impact-BAM，我们估计2016年英格兰和威尔士大约有767 000人(95%不确定区间735 000到797 000)患有痴呆症。尽管发病率和特定年龄段的患病率有所下降，但预计到2020年、2030年和2040年，痴呆症患者的数量将分别增加到872000 000、1 092 000和1 205 000。一项没有发病率下降的敏感性分析给出了一个更大的预期增长，到2040年，痴呆症患者将超过190万。结论年龄别痴呆发病率呈下降趋势。从2016年到2040年，英格兰和威尔士的痴呆症患者数量可能增加57%。这一增长主要是由预期寿命的提高推动的。
Objective To forecast dementia prevalence with a dynamic modelling approach that integrates calendar trends in dementia incidence with those for mortality and cardiovascular disease. Design Modelling study. Setting General adult population of England and Wales. Participants The English Longitudinal Study of Ageing (ELSA) is a representative panel study with six waves of data across 2002-13. Men and women aged 50 or more years, selected randomly, and their cohabiting partners were recruited to the first wave of ELSA (2002-03). 11392 adults participated (response rate 67%). To maintain representativeness, refreshment participants were recruited to the study at subsequent waves. The total analytical sample constituted 17 906 people. Constant objective criteria based on cognitive and functional impairment were used to ascertain dementia cases at each wave. Main outcome measures To estimate calendar trends in dementia incidence, correcting for bias due to loss to follow-up of study participants, a joint model of longitudinal and time-to-event data was fitted to ELSA data. To forecast future dementia prevalence, the probabilistic Markov model IMPACT-BAM (IMPACT-Better Ageing Model) was developed. IMPACT-BAM models transitions of the population aged 35 or more years through states of cardiovascular disease, cognitive and functional impairment, and dementia, to death. It enables prediction of dementia prevalence while accounting for the growing pool of susceptible people as a result of increased life expectancy and the competing effects due to changes in mortality, and incidence of cardiovascular disease. Results In ELSA, dementia incidence was estimated at 14.3 per 1000 person years in men and 17.0/1000 person years in women aged 50 or more in 2010. Dementia incidence declined at a relative rate of 2.7% (95% confidence interval 2.4% to 2.9%) for each year during 2002-13. Using IMPACT-BAM, we estimated there were approximately 767 000 (95% uncertainty interval 735 000 to 797 000) people with dementia in England and Wales in 2016. Despite the decrease in incidence and age specific prevalence, the number of people with dementia is projected to increase to 872 000, 1 092 000, and 1 205 000 in 2020, 2030, and 2040, respectively. A sensitivity analysis without the incidence decline gave a much larger projected growth, of more than 1.9 million people with dementia in 2040. Conclusions Age specific dementia incidence is declining. The number of people with dementia in England and Wales is likely to increase by 57% from 2016 to 2040. This increase is mainly driven by improved life expectancy.
心肌梗塞发病率的肥胖稳定下降：在怀特霍尔II队列中，英国男女的随访20年。
影响因子：
39.3
作者：
Hardoon SL;Morris RW;Whincup PH;Shipley MJ;Britton AR;Masset G;Stringhini S;Sabia S;Kivimaki M;Singh-Manoux A;Brunner EJ
通讯作者：
Brunner EJ