Contribution of chronic diseases to disability in elderly people in countries with low and middle incomes: a 10/66 Dementia Research Group population-based survey
Contribution of chronic diseases to disability in elderly people in countries with low and middle incomes: a 10/66 Dementia Research Group population-based survey
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DOI：
10.1016/s0140-6736(09)61829-8
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发表时间：
2009-11-01
期刊：
影响因子：
168.9
通讯作者：
Prince, Martin
中科院分区：
文献类型：
--
作者：
Sousa, Renata M.;Ferri, Cleusa P.;Prince, Martin
背景 对中低收入国家老年人残疾的研究很少；根据全球疾病负担估计，视力障碍是导致该人群残疾多年的主要原因。我们旨在评估身体、精神和认知慢性疾病对残疾的影响，以及社会人口和健康特征对残疾地理差异的影响程度。 方法 我们对 7 个中低收入国家（中国、印度、古巴、多米尼加共和国、委内瑞拉、墨西哥和秘鲁）的 11 个地点的 65 岁以上居民 (n=15 022) 进行了横断面调查。残疾情况按照 12 项世界卫生组织残疾评估表 2.0 进行评估。通过临床评估确定痴呆、抑郁、高血压和慢性阻塞性肺疾病；自我报告诊断的糖尿病、中风和心脏病；以及自我报告的损伤引起的感觉、胃肠道、皮肤、四肢和关节炎疾病。通过零膨胀负二项回归和泊松回归来评估对残疾分数的独立贡献，以生成人口归因患病率 (PAPF)。调查结果在印度农村和委内瑞拉以外的地区，痴呆症对残疾的贡献最大（中位 PAPF 25.1% [IQR 19.2-43.6]）。其他重要因素包括中风（11.4% [1.8-21.4]）、肢体损伤（10.5% [5.7-33.8]）、关节炎（9.9% [3.2-34.8]）、抑郁症（8.3% [0.5-23.0]）、视力问题（6.8% [1.7-17.6]）和胃肠道损伤（6.5%） [0.3-23.1]）。与慢性病相关的疾病占普遍残疾的大约三分之二。当考虑到零通货膨胀时，不同地区残疾分数的差异很大程度上归因于健康和社会人口特征的构成差异。 解释 根据实证研究，痴呆症，而不是失明，是中低收入国家老年人残疾的最重要的独立因素。大脑和精神的慢性疾病值得更加重视。除了残疾之外，它们还会导致依赖性，并给护理人员带来压力、复杂、长期的挑战。社会成本是巨大的。
Background Disability in elderly people in countries with low and middle incomes is little studied; according to Global Burden of Disease estimates, visual impairment is the leading contributor to years lived with disability in this population. We aimed to assess the contribution of physical, mental, and cognitive chronic diseases to disability, and the extent to which sociodemographic and health characteristics account for geographical variation in disability.Methods We undertook cross-sectional surveys of residents aged older than 65 years (n=15 022) in 11 sites in seven countries with low and middle incomes (China, India, Cuba, Dominican Republic, Venezuela, Mexico, and Peru). Disability was assessed with the 12-item WHO disability assessment schedule 2.0. Dementia, depression, hypertension, and chronic obstructive pulmonary disease were ascertained by clinical assessment; diabetes, stroke, and heart disease by self-reported diagnosis; and sensory, gastrointestinal, skin, limb, and arthritic disorders by self-reported impairment. Independent contributions to disability scores were assessed by zero-inflated negative binomial regression and Poisson regression to generate population-attributable prevalence fractions (PAPF).Findings In regions other than rural India and Venezuela, dementia made the largest contribution to disability (median PAPF 25.1% [IQR 19.2-43.6]). Other substantial contributors were stroke (11.4% [1.8-21.4]), limb impairment (10.5% [5.7-33.8]), arthritis (9.9% [3.2-34.8]), depression (8.3% [0.5-23.0]), eyesight problems (6.8% [1.7-17.6]), and gastrointestinal impairments (6.5% [0.3-23.1]). Associations with chronic diseases accounted for around two-thirds of prevalent disability. When zero inflation was taken into account, between-site differences in disability scores were largely attributable to compositional differences in health and sociodemographic characteristics.Interpretation On the basis of empirical research, dementia, not blindness, is overwhelmingly the most important independent contributor to disability for elderly people in countries with low and middle incomes. Chronic diseases of the brain and mind deserve increased prioritisation. Besides disability, they lead to dependency and present stressful, complex, long-term challenges to carers. Societal costs are enormous.