中国四省55岁及以上人群轻度认知功能障碍变化情况及其人口经济学影响

Changes in mild cognitive impairment and sociodemographic disparity among adults aged 55 years and above in 4 provinces of China

目的探讨中国河北省、浙江省、陕西省和湖南省(四省)≥55岁人群轻度认知功能障碍(mild cognitive impairment,MCI)变化情况及其人口经济学影响。方法选取“神经系统疾病专病社区队列研究”未患阿尔兹海默病、参与两轮调查、具有完整的基线人口经济学数据及两轮认知功能数据者4687人,采用广义估计方程分析人口经济学因素对MCI的影响。结果2018年和2020年中国四省≥55岁未患阿尔兹海默病人群MCI检出率分别为48.56%和42.56%。基线认知功能正常(normal cognition,NC)者MCI发生率为30.11%,基线MCI者逆转率为44.24%。多因素分析结果显示,随年龄增加、家庭人均月收入降低,MCI发生风险增加,MCI逆转可能性减小。在基线NC人群中,初中及以上组发生MCI的风险比文盲组低35%(RR=0.65,95%CI 0.53~0.80);居住在农村者MCI发生风险较城市居民低(RR=0.56,95%CI 0.49~0.65);有慢性病史者发生MCI风险是无慢性病史者的1.17倍(95%CI 1.03~1.32)。在基线MCI人群中,随文化程度提升,MCI逆转可能性增加;有工作者MCI逆转可能性是无工作者的1.04倍(95%CI 1.00~1.08)。结论中国四省≥55岁人群MCI发生率和逆转率均较高。高龄、文化程度低、收入水平低是认知功能障碍的危险因素。

OBJECTIVE To investigate the changes in mnild cognitive impairment(MCI)and sociodemographic disparity among adults aged 55 years and above in 4 provinces of China.METHODS A total of 4687 adults aged 55 years and above from Community-based Cohort Study on Nervous System Disease who did not have Alzheimer's disease,participated in both rounds of the survey,and had complete baseline sociodemographic data and two rounds of data on cognitive function were selected.Generalized estimation equations were used to analyse the effect of sociodemographic factors on MCI.RESULTS The detection rates of MCI in adults aged 55 years and above without Alzheimer's disease in 4 provinces of China in 2018 and 2020 were 48.56%and 42.56%respectively.MCI occurred in 30.11%of those with normal cognition(NC)at baseline,and 44.24%of those with MCI at baseline reverted to NC.The risk of MCI increased and the likelihood of MCI reversion decreased with increasing age and decreasing per capita monthly household income.In the baseline NC population,the risk of MCI in the junior high school and above group was 35%lower than that in the illiterate group(RR=0.65,95%CI 0.53-0.80),the risk of MCI was lower in those living in rural areas(RR=0.56,95%CI 0.49-0.65),and the risk of MCI was 1.17 times(95%CI 1.03-1.32)higher in those with a history of chronic diseases than in those without it.In the baseline MCI population,the likelihood of MCI reversion increased with education,the likelihood of MCI reversion was 1.O04 times higher for workers than for non-workers(95%CI 1.00-1.08).CONCLUSION The incidence and reversal rates of MCI were high in adults aged≥55 years in four provinces of China.Advanced age,low education and low income level are risk factors for cognitive dysfunction.