湖北省社区65岁及以上老年人痴呆患病率及其与多病共患的关联性

Prevalence of dementia and its correlation with multimorbidity in community-dwelling older adults aged 65 and over in Hubei Province

目的探究社区老年人痴呆患病率及其危险因素,重点分析多病共患与痴呆患病的关联。方法研究对象来自湖北老年记忆队列(注册号:ChiCTR1800019164)的基线调查(2018―2020年)数据,根据统一纳入排除标准,共纳入8221名≥65岁老人,他们完成全套神经心理评估和临床体检。根据高血压、糖尿病、冠心病及脑血管疾病共病状态(多病共患为同时患有两种或以上的慢性病)将研究对象分为两组:无共患病组、共患病组,基于居住地采用多因素logistic回归分析模型分析痴呆危险因素。结果总人群、城市人群和农村人群的痴呆标化患病率分别为7.06%(95%CI:6.40%~7.72%)、4.34%(95%CI:3.81%~4.87%)和11.53%(95%CI:10.70%~12.35%),其中共患病者的痴呆患病率均高于无共患病者的痴呆患病率。高龄、无配偶、体力活动缺乏及智力活动缺乏是痴呆患病的危险因素,多病共患与痴呆有紧密的联系。共患病组的痴呆患病风险为无共患病组的1.299倍(OR=1.299,95%CI:1.079~1.563,P=0.006)。结论慢性病共患增加痴呆的患病风险,农村与城市人群差异明显,因此需要针对社区老年人群开展痴呆及多病共患的干预,落实家庭医生制,以降低痴呆患病率。

Objective To investigate the prevalence and risk factors of dementia in community-dwelling older adults,with a specific focus on analyzing the association between multimorbidity and dementia.Methods The study participants were from the baseline survey(2018-2020)of the Hubei memory and aging cohort study(registration number:ChiCTR1800019164).According to the unified inclusion and exclusion criteria,a total of 8221 elderly people≥65 years old were included,who had completed a complete set of neuropsychological assessments and clinical physical examinations.The participants were divided into two groups according to their comorbidity status,including hypertension,diabetes,coronary heart disease,and cerebrovascular disease,i.e.non-comorbidity group(including having no chronic disease or only one disease),comorbidity group(having two or more chronic diseases).Multivariate logistic regression was used to analyze the risk factors for dementia based on residence.Results The standardized prevalence of dementia was 7.06%(95%CI:6.40%-7.72%),4.34%(95%CI:3.81%-4.87%),and 11.53%(95%CI:10.70%-12.35%)in the total population,urban population and rural population,respectively,and the prevalence of dementia in individuals with comorbidities was higher than that in those without comorbidities.Older age,no spouse,lack of physical activity,and lack of intellectual activity were risk factors for dementia.Multimordism was closely related to dementia.The risk of dementia in the comorbidity group was 1.299 times higher than that in the non-comorbidity group(OR=1.299,95%CI:1.079-1.563,P=0.006).Conclusions Dementia prevalence significantly increased with the presence of chronic disease comorbidity,with a noteworthy difference between rural and urban residents.This finding underscores the demand of dementia and multimorbidity interventions among community-dwelling elderly populations,suggesting the implementation of the family doctor system to mitigate dementia prevalence.