Birth in High Infant Mortality States and Dementia Risk in a Cohort of Elderly African American and White Health Care Members.
Birth in High Infant Mortality States and Dementia Risk in a Cohort of Elderly African American and White Health Care Members.
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DOI：
10.1097/wad.0000000000000270
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发表时间：
2019-01
影响因子：
2.1
通讯作者：
Whitmer RA
中科院分区：
文献类型：
--
作者：
Gilsanz P;Mayeda ER;Glymour MM;Quesenberry CP Jr;Mungas D;DeCarli CS;Whitmer RA
在婴儿死亡率高的地区出生与更糟糕的长期健康结果有关，但它是否会影响痴呆症风险完全未知。从1996年到2015年，对6，268名医疗保健人员进行了痴呆症诊断。从1928年开始，出生状态的婴儿死亡率按四分位数排列（婴儿死亡率最差的四分位数范围：白人：69-129例死亡/1 000例活产，非白人：129-277例死亡/1 000例活产）。考克斯比例风险模型估计与出生状态IMR四分位数调整人口统计学和生命周期健康指标相关的痴呆风险。与在最差IMR四分位数的州以外出生的白人相比，在最差IMR四分位数的州出生的非裔美国人痴呆风险增加了92%（HR=1.92; 95%CI：1.42，2.59），在这些州以外出生的非裔美国人风险增加了36%（HR=1.36; 95%CI：1.20，1.53）。出生状态IMR和白人痴呆风险之间没有关联。在婴儿死亡率最高的州出生与非裔美国人痴呆风险升高有关，但与白人无关。婴儿死亡率的巨大绝对差异可能反映了非裔美国人经历的更严酷的幼儿期条件。这些发现表明，儿童时期的条件可能在痴呆症发病率的种族差异中发挥作用。
Birth in areas with high infant mortality rates (IMRs) has been linked to worse long-term health outcomes, yet it is completely unknown if it impacts dementia risk. 6,268 healthcare members were followed for dementia diagnosis from 1996–2015. Birth state IMRs from 1928 were ranked into quartile (worst IMRs quartile range: Whites: 69–129 deaths/1,000 live births, Non-Whites: 129–277 deaths/1,000 live births). Cox proportional hazard models estimated the dementia risk associated with birth state IMR quartile adjusting for demographics and lifecourse health indicators. Compared with Whites born outside of states in the worst IMR quartile, African Americans born in states in the worst IMR quartile had 92% increased dementia risk (HR=1.92; 95% CI: 1.42, 2.59), and African Americans born outside those states had 36% increased risk (HR=1.36; 95% CI: 1.20, 1.53). There was no association between birth state IMR and dementia risk among Whites. Birth in states with the highest rates of infant mortality was associated with elevated dementia risk among African Americans but not Whites. The large absolute difference in IMRs likely reflects harsher early-childhood conditions experienced by African Americans. These findings suggest that childhood conditions may play a role in racial disparities in dementia rates.