Geographical variation in dementia: systematic review with meta-analysis
Geographical variation in dementia: systematic review with meta-analysis
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DOI：
10.1093/ije/dys103
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发表时间：
2012-08-01
影响因子：
7.7
通讯作者：
Starr, John M.
中科院分区：
文献类型：
--
作者：
Russ, Tom C.;Batty, G. David;Starr, John M.
痴呆患病率和发病率的地理差异可能表明痴呆病因学的重要社会环境贡献。然而，以前的比较受到了阻碍，结合研究与不同的方法。本审查系统整理和综合研究的基础上使用相同的methods.Methods研究的流行率和痴呆症的发病率的地理变化进行比较，确定了一个全面的电子搜索相关的数据库，审查确定的出版物的参考部分，在该领域的专家联系和重新检查我们已经知道的论文。根据入选/排除标准对识别的文章进行独立审查，并根据地理范围进行考虑。结果共检索到文献12580条，纳入文献51篇。痴呆的患病率和发病率在从全国到小地区的许多尺度上都有变化，包括一些农村生活影响的证据[患病率比值比（OR）= 1.11，90%置信区间（CI）0.79-1.57;发病率OR = 1.20，90% CI 0.84-1.71]。然而，对于阿尔茨海默病来说，这种与农村生活的关联更强，特别是当捕捉到早期农村生活时（患病率OR = 2.22，90%CI 1.19-4.16;发病率OR = 1.64，90%CI 1.08-2.50）。结论有证据表明富裕国家痴呆症发病率在不同地理范围内存在地理差异。农村生活与阿尔茨海默病的风险增加有关，有一种说法认为，早期生活在农村会进一步增加这种风险。然而，在资源贫乏的国家进行的研究很少，这一事实限制了结论。
Background Geographical variation in dementia prevalence and incidence may indicate important socio-environmental contributions to dementia aetiology. However, previous comparisons have been hampered by combining studies with different methodologies. This review systematically collates and synthesizes studies examining geographical variation in the prevalence and incidence of dementia based on comparisons of studies using identical methodologies.Methods Papers were identified by a comprehensive electronic search of relevant databases, scrutinising the reference sections of identified publications, contacting experts in the field and re-examining papers already known to us. Identified articles were independently reviewed against inclusion/exclusion criteria and considered according to geographical scale. Rural/urban comparisons were meta-analysed.Results Twelve thousand five hundred and eighty records were reviewed and 51 articles were included. Dementia prevalence and incidence varies at a number of scales from the national down to small areas, including some evidence of an effect of rural living [prevalence odds ratio (OR) = 1.11, 90% confidence interval (CI) 0.79-1.57; incidence OR = 1.20, 90% CI 0.84-1.71]. However, this association of rurality was stronger for Alzheimer disease, particularly when early life rural living was captured (prevalence OR = 2.22, 90% CI 1.19-4.16; incidence OR = 1.64, 90% CI 1.08-2.50).Conclusions There is evidence of geographical variation in rates of dementia in affluent countries at a variety of geographical scales. Rural living is associated with an increased risk of Alzheimer disease, and there is a suggestion that early life rural living further increases this risk. However, the fact that few studies have been conducted in resource-poor countries limits conclusions.