Estimates of the Association of Dementia With US Mortality Levels Using Linked Survey and Mortality Records
Estimates of the Association of Dementia With US Mortality Levels Using Linked Survey and Mortality Records
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DOI：
10.1001/jamaneurol.2020.2831
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发表时间：
2020-12-01
期刊：
影响因子：
29
通讯作者：
Crimmins, Eileen M.
中科院分区：
文献类型：
--
作者：
Stokes, Andrew C.;Weiss, Jordan;Crimmins, Eileen M.
重要性生命统计数据是用于了解美国痴呆症死亡率负担的主要数据来源，尽管有证据表明痴呆症在死亡证明中被低估。替代估计，以人口为基础的samples，是necessar.Objective估计死亡的百分比归因于痴呆症在US.DESIGN，设置，和PARTICIPANTS一个前瞻性队列研究的健康和退休研究的非制度化的美国个人与基线暴露评估在2000年和后续通过2009年进行。数据分析时间为2018年11月至2020年5月。样本来自7489名年龄在70至99岁之间的成年人，他们直接或通过代理人进行了采访。排除了90名缺失协变量或样本权重的参与者和57名失访的参与者。最终的分析样本包括7342名成年人。使用健康和退休研究自我或代理报告的认知测量和经验证的Langa-Weir评分截止值，在基线时确定痴呆和无痴呆的认知障碍（CIND）。主要结果和测量使用考克斯比例风险回归模型估计痴呆和CIND状态与全因死亡率的风险比，解释协变量。并用于计算人群归因分数。结果进行了比较，从死亡certifications.Results总样本7342的死因信息，4348名参与者（60.3%）是妇女。在基线时。4533人（64.0%）年龄在70 - 79岁之间。2393人（31.0%）年龄在80 - 89岁之间，416人（5.0%）年龄在90 - 99岁之间;百分比加权。可归因于痴呆的死亡百分比为13.6%（95%CI。2000年至2009年期间为12.2%-15.0%。非西班牙裔黑人参与者中痴呆症的死亡负担显著较高（24.7%; 95%CI，17.3-31.4）比非西班牙裔白色参与者（12.2%; 95% CI，10.7-13.6）和高中以下教育程度的成年人（16.2%; 95%CI，13.2%-19.0%）与具有大学教育的人（9.8%; 95%CI，7.0%-12.5%）相比。死亡证明上记录的潜在死亡原因（5.0%; 95% CI，4.3%-5.8%）低估了痴呆对美国死亡率的贡献，低估了2.7倍。死亡归因于CIND揭示了一个更大的underestimation.CONCLUSIONS和RELEVANCE-本研究的结果表明，与痴呆症相关的死亡率负担被低估使用的重要统计数据，特别是当考虑CIND除了痴呆症。
IMPORTANCE Vital statistics are the primary source of data used to understand the mortality burden of dementia in the US, despite evidence that dementia is underreported on death certificates. Alternative estimates, drawing on population-based samples, are needed.OBJECTIVE To estimate the percentage of deaths attributable to dementia in the US.DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study of the Health and Retirement Study of noninstitutionalized US individuals with baseline exposure assessment in 2000 and follow-up through 2009 was conducted. Data were analyzed from November 2018 to May 2020. The sample was drawn from 7489 adults aged 70 to 99 years interviewed directly or by proxy. Ninety participants with missing covariates or sample weights and 57 participants lost to follow-up were excluded. The final analytic sample included 7342 adults.EXPOSURE Dementia and cognitive impairment without dementia (CIND) were identified at baseline using Health and Retirement Study self- or proxy-reported cognitive measures and the validated Langa-Weir score cutoff.MAIN OUTCOMES AND MEASURES Hazard ratios relating dementia and CIND status to all-cause mortality were estimated using Cox proportional hazards regression models, accounting for covariates, and were used to calculate population-attributable fractions. Results were compared with information on cause of death from death certificates.RESULTS Of the 7342 total sample, 4348 participants (60.3%) were women. At baseline. 4533 individuals (64.0%) were between ages 70 and 79 years. 2393 individuals (31.0%) were between 80 and 89 years, and 416 individuals (5.0%) were between 90 and 99 years; percentages were weighted. The percentage of deaths attributable to dementia was 13.6% (95% CI. 12.2%-15.0%) between 2000 and 2009. The mortality burden of dementia was significantly higher among non-Hispanic Black participants (24.7%; 95% CI, 17.3-31.4) than non-Hispanic White participants (12.2%; 95% CI, 10.7-13.6) and among adults with less than a high school education (16.2%; 95% CI, 13.2%-19.0%) compared with those with a college education (9.8%; 95% CI, 7.0%-12.5%). Underlying cause of death recorded on death certificates (5.0%; 95% CI, 4.3%-5.8%) underestimated the contribution of dementia to US mortality by a factor of 2.7. Incorporating deaths attributable to CIND revealed an even greater underestimation.CONCLUSIONS AND RELEVANCE The findings of this study suggest that the mortality burden associated with dementia is underestimated using vital statistics, especially when considering CIND in addition to dementia.