PDF(Pubmed)
Abstract：
BACKGROUND: Interest in modifiable risk factors (MRFs) for dementia is high, given the personal, social, and economic impact of the disorder, especially in ageing societies such as the United Kingdom. Exploring the population attributable fraction (PAF) of dementia attributable to MRFs and how this may have changed over time remains unclear. Unravelling the temporal dynamics of MRFs is crucial for informing the development of evidence-based and effective public health policies. This investigation examined the temporal trajectories of MRFs for dementia in England.
METHODS: We used data from the English Longitudinal Study of Ageing, a panel study over eight waves collected between 2004 and 2019 (76,904 interviews in total). We calculated the PAFs for twelve MRFs (including six early- to mid-life factors and six late-life factors), as recommended by the Lancet Commission, and the individual weighted PAFs (IW-PAFs) for each risk factor. Temporal trends were analysed to understand the changes in the overall PAF and IW-PAF over the study period. Subgroup analyses were conducted by sex and socioeconomic status (SES).
RESULTS: The overall PAF for dementia MRFs changed from 46.73% in 2004/2005 to 36.79% in 2018/2019, though this trend was not statistically significant. During 2004-2019, hypertension, with an average IW-PAF of 8.21%, was the primary modifiable determinant of dementia, followed by obesity (6.16%), social isolation (5.61%), hearing loss (4.81%), depression (4.72%), low education (4.63%), physical inactivity (3.26%), diabetes mellitus (2.49%), smoking (2.0%), excessive alcohol consumption (1.16%), air pollution (0.42%), and traumatic brain injury (TBI) (0.26%). During 2004-2019, only IW-PAFs of low education, social isolation, and smoking showed significant decreasing trends, while IW-PAFs of other factors either did not change significantly or increased (including TBI, diabetes mellitus, and air pollution). Upon sex-specific disaggregation, a higher overall PAF for MRFs was found among women, predominantly associated with later-life risk factors, most notably social isolation, depression, and physical inactivity. Additionally, hearing loss, classified as an early- to mid-life factor, played a supplementary role in the identified sex disparity. A comparable discrepancy was evident upon PAF evaluation by SES, with lower income groups experiencing a higher dementia risk, largely tied to later-life factors such as social isolation, physical inactivity, depression, and smoking. Early- to mid-life factors, in particular, low education and obesity, were also observed to contribute to the SES-associated divergence in dementia risk. Temporal PAF and IW-PAF trends, stratified by sex and SES, revealed that MRF PAF gaps across sex or SES categories have persisted or increased.
CONCLUSIONS: In England, there was little change over time in the proportion of dementia attributable to known modifiable risk factors. The observed trends underscore the continuing relevance of these risk factors and the need for targeted public health strategies to address them.
METHODS: We used data from the English Longitudinal Study of Ageing, a panel study over eight waves collected between 2004 and 2019 (76,904 interviews in total). We calculated the PAFs for twelve MRFs (including six early- to mid-life factors and six late-life factors), as recommended by the Lancet Commission, and the individual weighted PAFs (IW-PAFs) for each risk factor. Temporal trends were analysed to understand the changes in the overall PAF and IW-PAF over the study period. Subgroup analyses were conducted by sex and socioeconomic status (SES).
RESULTS: The overall PAF for dementia MRFs changed from 46.73% in 2004/2005 to 36.79% in 2018/2019, though this trend was not statistically significant. During 2004-2019, hypertension, with an average IW-PAF of 8.21%, was the primary modifiable determinant of dementia, followed by obesity (6.16%), social isolation (5.61%), hearing loss (4.81%), depression (4.72%), low education (4.63%), physical inactivity (3.26%), diabetes mellitus (2.49%), smoking (2.0%), excessive alcohol consumption (1.16%), air pollution (0.42%), and traumatic brain injury (TBI) (0.26%). During 2004-2019, only IW-PAFs of low education, social isolation, and smoking showed significant decreasing trends, while IW-PAFs of other factors either did not change significantly or increased (including TBI, diabetes mellitus, and air pollution). Upon sex-specific disaggregation, a higher overall PAF for MRFs was found among women, predominantly associated with later-life risk factors, most notably social isolation, depression, and physical inactivity. Additionally, hearing loss, classified as an early- to mid-life factor, played a supplementary role in the identified sex disparity. A comparable discrepancy was evident upon PAF evaluation by SES, with lower income groups experiencing a higher dementia risk, largely tied to later-life factors such as social isolation, physical inactivity, depression, and smoking. Early- to mid-life factors, in particular, low education and obesity, were also observed to contribute to the SES-associated divergence in dementia risk. Temporal PAF and IW-PAF trends, stratified by sex and SES, revealed that MRF PAF gaps across sex or SES categories have persisted or increased.
CONCLUSIONS: In England, there was little change over time in the proportion of dementia attributable to known modifiable risk factors. The observed trends underscore the continuing relevance of these risk factors and the need for targeted public health strategies to address them.
摘要：
背景：对痴呆症的可改变危险因素（MRF）的兴趣很高，鉴于个人，社会,以及混乱的经济影响，特别是在英国等老龄化社会。探索归因于MRF的痴呆的人群归因分数（PAF）以及这可能随着时间的推移而发生的变化尚不清楚。解开MRF的时间动态对于制定基于证据和有效的公共卫生政策至关重要。这项调查研究了英格兰痴呆症MRF的时间轨迹。
方法：我们使用了英国老龄化纵向研究的数据，2004年至2019年期间收集的八波小组研究(共76,904次采访)。我们计算了12个MRF的PAF（包括6个早至中年因素和6个晚年因素），根据柳叶刀委员会的建议，以及每个风险因素的单个加权PAF(IW-PAF)。分析了时间趋势，以了解研究期间总体PAF和IW-PAF的变化。按性别和社会经济地位（SES）进行亚组分析。
结果：痴呆症MRF的总体PAF从2004/2005年的46.73%变化到2018/2019年的36.79%，尽管这一趋势没有统计学意义。在2004-2019年期间，高血压，平均IW-PAF为8.21%，是痴呆症的主要可改变的决定因素，其次是肥胖(6.16%)，社会隔离（5.61%），听力损失（4.81%），抑郁症（4.72%），教育程度低(4.63%),缺乏体力活动(3.26%)，糖尿病（2.49%），吸烟(2.0%)，过量饮酒(1.16%)，空气污染(0.42%),和创伤性脑损伤（TBI）（0.26%）。在2004-2019年期间，只有低教育程度的IW-PAF，社会孤立,吸烟呈显著下降趋势，而其他因素的IW-PAF没有显著变化或增加(包括TBI，糖尿病,空气污染）。根据性别分类，在女性中发现了更高的MRF总体PAF，主要与晚年风险因素相关，最值得注意的是社会孤立，抑郁症,缺乏体力活动。此外,听力损失,被归类为早期到中期的因素，在确定的性别差异中发挥了补充作用。在SES的PAF评估中，相当的差异是明显的，低收入群体患痴呆症的风险更高，很大程度上与诸如社会隔离之类的晚年因素有关，缺乏身体活动，抑郁症,和吸烟。早期到中年的因素，特别是,低教育和肥胖，还观察到与SES相关的痴呆风险差异。时间PAF和IW-PAF趋势，按性别和SES分层，揭示了性别或SES类别之间的MRFPAF差距已经持续或增加。
结论：在英格兰，已知可改变的危险因素导致的痴呆比例随时间变化不大.观察到的趋势强调了这些风险因素的持续相关性，以及有针对性的公共卫生战略来应对这些风险因素的必要性。
方法：我们使用了英国老龄化纵向研究的数据，2004年至2019年期间收集的八波小组研究(共76,904次采访)。我们计算了12个MRF的PAF（包括6个早至中年因素和6个晚年因素），根据柳叶刀委员会的建议，以及每个风险因素的单个加权PAF(IW-PAF)。分析了时间趋势，以了解研究期间总体PAF和IW-PAF的变化。按性别和社会经济地位（SES）进行亚组分析。
结果：痴呆症MRF的总体PAF从2004/2005年的46.73%变化到2018/2019年的36.79%，尽管这一趋势没有统计学意义。在2004-2019年期间，高血压，平均IW-PAF为8.21%，是痴呆症的主要可改变的决定因素，其次是肥胖(6.16%)，社会隔离（5.61%），听力损失（4.81%），抑郁症（4.72%），教育程度低(4.63%),缺乏体力活动(3.26%)，糖尿病（2.49%），吸烟(2.0%)，过量饮酒(1.16%)，空气污染(0.42%),和创伤性脑损伤（TBI）（0.26%）。在2004-2019年期间，只有低教育程度的IW-PAF，社会孤立,吸烟呈显著下降趋势，而其他因素的IW-PAF没有显著变化或增加(包括TBI，糖尿病,空气污染）。根据性别分类，在女性中发现了更高的MRF总体PAF，主要与晚年风险因素相关，最值得注意的是社会孤立，抑郁症,缺乏体力活动。此外,听力损失,被归类为早期到中期的因素，在确定的性别差异中发挥了补充作用。在SES的PAF评估中，相当的差异是明显的，低收入群体患痴呆症的风险更高，很大程度上与诸如社会隔离之类的晚年因素有关，缺乏身体活动，抑郁症,和吸烟。早期到中年的因素，特别是,低教育和肥胖，还观察到与SES相关的痴呆风险差异。时间PAF和IW-PAF趋势，按性别和SES分层，揭示了性别或SES类别之间的MRFPAF差距已经持续或增加。
结论：在英格兰，已知可改变的危险因素导致的痴呆比例随时间变化不大.观察到的趋势强调了这些风险因素的持续相关性，以及有针对性的公共卫生战略来应对这些风险因素的必要性。
