Non-Cancer Chronic Pain Conditions and Risk for Incident Alzheimer's Disease and Related Dementias in Community-Dwelling Older Adults: A Population-Based Retrospective Cohort Study of United States Medicare Beneficiaries, 2001-2013
Non-Cancer Chronic Pain Conditions and Risk for Incident Alzheimer's Disease and Related Dementias in Community-Dwelling Older Adults: A Population-Based Retrospective Cohort Study of United States Medicare Beneficiaries, 2001-2013
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DOI：
10.3390/ijerph17155454
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发表时间：
2020-08-01
影响因子：
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通讯作者：
Innes, Kim E.
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文献类型：
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作者：
Khalid, Sumaira;Sambamoorthi, Usha;Innes, Kim E.
越来越多的证据表明，某些慢性疼痛状况可能会增加阿尔茨海默病和相关痴呆(ADRD)的风险。严格的纵向研究仍然相对稀少，总体慢性疼痛状况负担与ADRD风险的关系研究仍然很少，睡眠和情绪障碍的潜在中介作用也是如此。在这项回溯性队列研究中，我们调查了基线常见的非癌症慢性疼痛状况(NCPC)与随后发生ADRD的风险的关系，并使用来自美国联邦医疗保险当前受益者调查(MCBS)的11个汇集队列(2001-2013年)的基线和2年随访数据，评估了情绪和睡眠障碍的潜在中介作用。研究样本包括16,934名居住在社区的成年人，年龄=65岁，基线时没有ADRD。NCPC包括：头痛、骨关节炎、关节痛、背部或颈部疼痛和神经病理性疼痛，使用索赔数据确定；事件ADRD(N=1149)使用索赔和调查数据确定。在调整了社会人口学、生活方式特征、病史、用药和其他因素后，基线的NCPC仍然与ADRD事件相关(调整后的优势比(AOR)为1.21，95%可信区间(CI)=1.04-1.4；p=0.003)；这种关联的强度和程度随着确诊的NCPC数量的增加而显著增加(4+条件下的AOR=1.91，CI=1.31-2.8，p-趋势和0.00001)。将睡眠障碍和/或抑郁/焦虑包括在内，略微降低了这些风险估计。敏感性分析也得出了类似的结论。NCPC与ADRD的发生显著正相关；这种关联可能部分通过情绪和睡眠障碍来调节。为了证实和扩展我们的发现，有必要进行更多的前瞻性研究，并进行更长期的随访。
Accumulating evidence suggests that certain chronic pain conditions may increase risk for incident Alzheimer's disease and related dementias (ADRD). Rigorous longitudinal research remains relatively sparse, and the relation of overall chronic pain condition burden to ADRD risk remains little studied, as has the potential mediating role of sleep and mood disorders. In this retrospective cohort study, we investigated the association of common non-cancer chronic pain conditions (NCPC) at baseline to subsequent risk for incident ADRD, and assessed the potential mediating effects of mood and sleep disorders, using baseline and 2-year follow-up data using 11 pooled cohorts (2001-2013) drawn from the U.S. Medicare Current Beneficiaries Survey (MCBS). The study sample comprised 16,934 community-dwelling adults aged >= 65 and ADRD-free at baseline. NCPC included: headache, osteoarthritis, joint pain, back or neck pain, and neuropathic pain, ascertained using claims data; incident ADRD (N = 1149) was identified using claims and survey data. NCPC at baseline remained associated with incident ADRD after adjustment for sociodemographics, lifestyle characteristics, medical history, medications, and other factors (adjusted odds ratio (AOR) for any vs. no NCPC = 1.21, 95% confidence interval (CI) = 1.04-1.40;p= 0.003); the strength and magnitude of this association rose significantly with increasing number of diagnosed NCPCs (AOR for 4+ vs. 0 conditions = 1.91, CI = 1.31-2.80,p-trend < 0.00001). Inclusion of sleep disorders and/or depression/anxiety modestly reduced these risk estimates. Sensitivity analyses yielded similar findings. NCPC was significantly and positively associated with incident ADRD; this association may be partially mediated by mood and sleep disorders. Additional prospective studies with longer-term follow-up are warranted to confirm and extend our findings.