2021 Alzheimer's disease facts and figures
2021 Alzheimer's disease facts and figures
复制标题
DOI：
10.1002/alz.12328
复制
发表时间：
2021-03-23
影响因子：
14
通讯作者：
中科院分区：
文献类型：
--
作者：
本文描述了阿尔茨海默病（AD）对公共卫生的影响，包括发病率和流行率、死亡率和发病率、护理的使用和成本，以及对护理者和社会的总体影响。特别报告讨论了在美国为痴呆症患者提供公平的医疗保健所面临的挑战。据估计，目前有620万65岁及以上的美国人患有阿尔茨海默氏痴呆症。到2060年，这一数字可能会增长到1380万，这阻碍了预防、减缓或治愈阿尔茨海默病的医学突破的发展。官方死亡证明显示，2019年有121499人死于阿尔茨海默病，这是可获得数据的最近一年，使阿尔茨海默病成为美国第六大死亡原因，也是65岁及以上美国人的第五大死亡原因。2000年至2019年期间，中风、心脏病和艾滋病毒导致的死亡人数下降，而阿尔茨海默病报告的死亡人数增加了145%以上。2020年COVID-19大流行可能加剧了阿尔茨海默病的死亡趋势。2020年，1100多万家庭成员和其他无偿护理人员为阿尔茨海默氏症或其他痴呆症患者提供了约153亿小时的护理。这些数字反映出，与十年前相比，护理人员的数量有所减少，而每位剩余的护理人员所提供的护理数量有所增加。2020年，无偿痴呆症护理的价值为2567亿美元。然而，它的成本还包括家庭照顾者情绪困扰和负面身心健康结果的风险增加——COVID-19加剧了这一成本。65岁及以上老年痴呆症或其他痴呆症患者的人均医疗保险支付额是没有这些疾病的受益人的三倍多，而医疗补助支付额是后者的23倍多。2021年，65岁及以上痴呆症患者的医疗保健、长期护理和临终关怀服务支出总额估计为3550亿美元。尽管多年来一直在努力使美国的医疗保健更加公平，但种族和族裔差异仍然存在——无论是在健康方面的差异，这涉及疾病负担的差异，还是在医疗保健方面的差异，这涉及使用医疗保健服务的能力的差异。与白人相比，黑人、西班牙裔美国人、亚裔美国人和印第安人的疾病负担仍然更高，获得医疗保健的机会也更少。这种差异在2019冠状病毒病期间变得更加明显，并延伸到痴呆症护理。阿尔茨海默病协会委托进行的调查最近揭示了歧视在痴呆症护理中的作用，种族和民族群体在医学研究中的不同信任程度，以及不同群体对阿尔茨海默病的关注和认识程度的差异。这些发现强调了在痴呆症护理人员和阿尔茨海默氏症临床试验中增加种族和民族多样性的必要性。
This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the challenges of providing equitable health care for people with dementia in the United States. An estimated 6.2 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available, making Alzheimer's the sixth-leading cause of death in the United States and the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated in 2020 by the COVID-19 pandemic. More than 11 million family members and other unpaid caregivers provided an estimated 15.3 billion hours of care to people with Alzheimer's or other dementias in 2020. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $256.7 billion in 2020. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2021 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $355 billion. Despite years of efforts to make health care more equitable in the United States, racial and ethnic disparities remain - both in terms of health disparities, which involve differences in the burden of illness, and health care disparities, which involve differences in the ability to use health care services. Blacks, Hispanics, Asian Americans and Native Americans continue to have a higher burden of illness and lower access to health care compared with Whites. Such disparities, which have become more apparent during COVID-19, extend to dementia care. Surveys commissioned by the Alzheimer's Association recently shed new light on the role of discrimination in dementia care, the varying levels of trust between racial and ethnic groups in medical research, and the differences between groups in their levels of concern about and awareness of Alzheimer's disease. These findings emphasize the need to increase racial and ethnic diversity in both the dementia care workforce and in Alzheimer's clinical trials.