Dementia and disadvantage in the USA and England: population-based comparative study.
Dementia and disadvantage in the USA and England: population-based comparative study.
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DOI：
10.1136/bmjopen-2020-045186
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发表时间：
2021-10-06
期刊：
影响因子：
2.9
通讯作者：
McCauley J
中科院分区：
文献类型：
--
作者：
Arapakis K;Brunner E;French E;McCauley J
比较美国和英国的痴呆症患病率及其随社会经济地位（SES）的变化。基于人口的比较研究。美国和英国70岁以上的非西班牙裔白人。数据来自健康与退休研究和英国老龄化纵向研究，这是协调的，全国代表性的小组研究。样本分别包括美国和英国的5330和3147人。在SES梯度上，年龄-性别标准化痴呆症患病率的国家间差异。每个国家的痴呆症患病率都是使用基于一套相同的人口统计、认知和功能措施的算法估计的。在这两个国家中，痴呆症的患病率在弱势群体中较高，根据四项社会经济地位指标，美国的不平等程度更高。英国的总体患病率为9.7%（95% CI 8.9%-10.6%），低于美国的11.2%（95% CI 10.6%-11.8%），差异为1.4个百分点（pp）（p=0.0055）。大多数国家之间的差异是由社会经济地位分布的底部驱动的。在最低收入的十分位数中，美国的患病率比英国高7.3pp（p<0.0001）。一旦过去的健康因素和教育得到控制，大多数国家内部的不平等现象就消失了;然而，最低收入十分之一人群的流行率的跨国差异仍然不成比例地高。在美国和英国，痴呆症患病率根据收入、财富和教育程度存在不平等。英格兰的痴呆症患病率较低，SES梯度也不太陡。大部分的跨国差异集中在社会经济地位最低的群体中，这提供了证据表明，在美国，不利因素是痴呆症的高风险因素。
To compare dementia prevalence and how it varies by socioeconomic status (SES) across the USA and England. Population-based comparative study. Non-Hispanic whites aged over 70 population in the USA and England. Data from the Health and Retirement Study and the English Longitudinal Study of Ageing, which are harmonised, nationally representative panel studies. The sample includes 5330 and 3147 individuals in the USA and England, respectively. Between country differences in age-gender standardised dementia prevalence, across the SES gradient. Dementia prevalence was estimated in each country using an algorithm based on an identical battery of demographic, cognitive and functional measures. Dementia prevalence is higher among the disadvantaged in both countries, with the USA being more unequal according to four measures of SES. Overall prevalence was lower in England at 9.7% (95% CI 8.9% to 10.6%) than the USA at 11.2% (95% CI 10.6% to 11.8%), a difference of 1.4 percentage points (pp) (p=0.0055). Most of the between country difference is driven by the bottom of the SES distribution. In the lowest income decile individuals in the USA had 7.3 pp (p<0.0001) higher prevalence than in England. Once past health factors and education were controlled for, most of the within country inequalities disappeared; however, the cross-country difference in prevalence for those in lowest income decile remained disproportionately high. There is inequality in dementia prevalence according to income, wealth and education in both the USA and England. England has lower dementia prevalence and a less steep SES gradient. Most of the cross-country difference is concentrated in the lowest SES group, which provides evidence that disadvantage in the USA is a disproportionately high risk factor for dementia.
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DOI：
10.1001/jama.2016.4226
发表时间：
2016-04-26
期刊：
JAMA
影响因子：
--
作者：
Chetty R;Stepner M;Abraham S;Lin S;Scuderi B;Turner N;Bergeron A;Cutler D
通讯作者：
Cutler D
影响因子：
5.4
作者：
Gianattasio, Kan Z.;Wu, Qiong;Power, Melinda C.
通讯作者：
Power, Melinda C.
影响因子：
5.6
作者：
Nguyen, Thu T.;Tchetgen, Eric J. Tchetgen;Glymour, M. Maria
通讯作者：
Glymour, M. Maria
影响因子：
5.4
作者：
WAGSTAFF, A;PACI, P;VANDOORSLAER, E
通讯作者：
VANDOORSLAER, E
影响因子：
7.7
作者：
Steptoe, Andrew;Breeze, Elizabeth;Nazroo, James
通讯作者：
Nazroo, James