Access to primary care and cognitive impairment: results from a national community study of aging Americans.
Access to primary care and cognitive impairment: results from a national community study of aging Americans.
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DOI：
10.1186/s12877-021-02545-8
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发表时间：
2021-10-20
期刊：
影响因子：
4.1
通讯作者：
Clarke PJ
中科院分区：
文献类型：
--
作者：
Mullins MA;Bynum JPW;Judd SE;Clarke PJ
尽管阿尔茨海默病和相关痴呆（ADRD）在美国的负担越来越重，但卫生保健与预防认知障碍之间的关系尚不清楚。初级保健管理痴呆的风险导致条件和风险降低行为，因此我们在卒中地理和种族差异的原因（REGARDS）研究中研究了个体和地区一级获得初级保健与认知障碍之间的关系。在基线就诊时进行认知评估和血管测量的REGARDS参与者被纳入本横断面分析。认知障碍定义为六项筛选（SIS）评分< 5。根据参与者的住址，在初级保健服务区（PCSA）水平上测量初级保健供应、初级保健利用和急诊科（ED）利用。个人获得护理的情况是自我报告的。根据人口统计学、社会经济地位和行为风险因素对模型进行了调整。在25,563名成年人中，生活在初级保健供应低的PCSA中，认知功能障碍的几率增加25% （OR 1.25 CI 1.07-1.45）。没有正规的医疗保健来源与认知障碍的几率增加14%相关（OR 1.14 CI 1.02-1.28），生活在急诊科使用率高的PCSA中与认知障碍的几率增加12%相关（OR 1.12 CI 1.02-1.23）。我们的研究结果是了解卫生保健如何预防认知障碍的重要的第一步。他们强调了初级保健的重要性，并建议未来的工作明确其在预防认知能力下降中的作用是势在必行的。在线版本包含补充材料，可在10.1186/s12877-021-02545-8获得。
Despite a growing burden of Alzheimer’s Disease and related dementias (ADRD) in the US, the relationship between health care and cognitive impairment prevention is unclear. Primary care manages risk causing conditions and risk reducing behaviors for dementia, so we examine the association between individual and area-level access to primary care and cognitive impairment in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. REGARDS participants with a cognitive assessment and vascular measurements at their baseline visit were included in this cross-sectional analysis. Cognitive impairment was defined as a Six-Item Screener (SIS) score < 5. Primary care supply, primary care utilization and emergency department (ED) utilization were measured at the primary care service area (PCSA) level based on participant’s address. Individual access to care was self-reported. Models were adjusted for confounding by demographics, socioeconomic status and behavioral risk factors. Among 25,563 adults, living in a PCSA with low primary care supply was associated with 25% higher odds of cognitive impairment (OR 1.25 CI 1.07-1.45). Not having a regular source of medical care was associated with 14% higher odds of cognitive impairment (OR 1.14 CI 1.02-1.28), and living in a PCSA with high emergency department utilization was associated with 12% higher odds of cognitive impairment (OR 1.12 CI 1.02-1.23). Our results are an important first step in understanding how health care may prevent cognitive impairment. They highlight the importance of primary care and suggest future work clarifying its role in preventing cognitive decline is imperative. The online version contains supplementary material available at 10.1186/s12877-021-02545-8.
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影响因子：
3.4
作者：
Goodman, DC;Mick, SS;Carretta, HJ
通讯作者：
Carretta, HJ
DOI：
10.1016/s0140-6736(17)31363-6
发表时间：
2017-12-16
期刊：
Lancet (London, England)
影响因子：
--
作者：
Livingston, Gill;Sommerlad, Andrew;Mukadam, Naaheed
通讯作者：
Mukadam, Naaheed
影响因子：
3.4
作者：
Butler, Danielle C.;Petterson, Stephen;Bazemore, Andrew W.
通讯作者：
Bazemore, Andrew W.
影响因子：
2.8
作者：
Auchincloss, AH;Van Nostrand, JF;Ronsaville, D
通讯作者：
Ronsaville, D
影响因子：
3.4
作者：
Chang, Chiang-Hua;O'Malley, A. James;Goodman, David C.
通讯作者：
Goodman, David C.