Cognitive impairment in the U.S.: Lifetime risk, age at onset, and years impaired
Cognitive impairment in the U.S.: Lifetime risk, age at onset, and years impaired
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DOI：
10.1016/j.ssmph.2020.100577
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发表时间：
2020-08-01
影响因子：
4.7
通讯作者：
Myrskyla, Mikko
中科院分区：
文献类型：
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作者：
Hale, Jo Mhairi;Schneider, Daniel C.;Myrskyla, Mikko
先前的研究分析了认知障碍的负担，但通常使用潜在偏倚的基于患病率的方法或仅测量患有障碍的年数，而不估计其他相关指标。我们使用健康和退休研究（1998-2014; n = 29，304）和基于首选发病率的马尔可夫链模型来评估认知障碍负担的三个关键指标：终身风险，平均发病年龄和受损年数。我们分析了轻度和重度认知障碍（痴呆）以及性别、种族/民族和教育程度的差异。我们的研究结果描绘了认知健康的多维图景，首次全面分析了美国50岁及以上人群的认知障碍负担。大约三分之二的美国人在平均年龄约70岁时经历某种程度的认知障碍。对于痴呆症，女性（男性）的终生风险为37%（24%），平均发病年龄为83（79）岁。轻度损伤的女性预期寿命为4.2年，痴呆症为3.2年，男性为3.5年和1.8年。一个关键的发现是，对于大多数少数群体（即，白色和/或受过高等教育的人），认知障碍在生命的最后阶段既被延迟又被压缩。相比之下，尽管弱势亚群体（黑人和/或受教育程度较低）的寿命较短，但他们的发病年龄更小，终生风险更高，认知受损的时间更长。例如，至少拥有副学士学位的男性有21%的终身痴呆风险，而高中以下教育的男性则为35%。白色妇女有6年的认知受损预期寿命，而黑人妇女和拉丁美洲妇女的预期寿命分别为12年和13年。这些教育和种族/民族梯度突出了认知障碍的非常不平衡的负担。需要进一步的研究来确定驱动认知障碍中这些差异的机制。
Prior studies have analyzed the burden of cognitive impairment, but often use potentially biased prevalence-based methods or measure only years lived with impairment, without estimating other relevant metrics. We use the Health and Retirement Study (1998-2014; n = 29,304) and the preferred incidence-based Markov-chain models to assess three key measures of the burden of cognitive impairment: lifetime risk, mean age at onset, and number of years lived impaired. We analyze both mild and severe cognitive impairment (dementia) and gender, racial/ethnic, and educational variation in impairment. Our results paint a multi-dimensional picture of cognitive health, presenting the first comprehensive analysis of the burden of cognitive impairment for the U.S. population age 50 and older. Approximately two out of three Americans experience some level of cognitive impairment at an average age of approximately 70 years. For dementia, lifetime risk for women (men) is 37% (24%) and mean age at onset 83 (79) years. Women can expect to live 4.2 years with mild impairment and 3.2 with dementia, men 3.5 and 1.8 years. A critical finding is that for the most advantaged groups (i.e., White and/or higher educated), cognitive impairment is both delayed and compressed toward the very end of life. In contrast, despite the shorter lives of disadvantaged subgroups (Black and/or lower educated), they experience a younger age of onset, higher lifetime risk, and more years cognitively impaired. For example, men with at least an Associate degree have 21% lifetime dementia risk, compared to 35% among men with less than high school education. White women have 6 years of cognitively-impaired life expectancy, compared to 12 and 13 years among Black women and Latinas. These educational and racial/ethnic gradients highlight the very uneven burden of cognitive impairment. Further research is required to identify the mechanisms driving these disparities in cognitive impairment.