Abstract：
Dementia incidence is lower among Asian Americans than Whites, despite higher prevalence of type 2 diabetes, a well-known dementia risk factor. Determinants of dementia, including type 2 diabetes, have rarely been studied in Asian Americans. We followed 4,846 Chinese, 4,129 Filipino, 2,784 Japanese, 820 South Asian, and 123,360 non-Latino White members of a California-based integrated healthcare delivery system from 2002-2020. We estimated dementia incidence rates by race/ethnicity and type 2 diabetes status, and fit Cox proportional hazards and Aalen additive hazards models for the effect of type 2 diabetes (assessed 5 years before baseline) on age of dementia diagnosis controlling for sex/gender, educational attainment, nativity, height, race/ethnicity, and a race/ethnicity*diabetes interaction. Type 2 diabetes was associated with higher dementia incidence in Whites (hazard ratio [HR] 1.46, 95% confidence interval [CI] 1.40-1.52). Compared with Whites, the estimated effect of diabetes was larger in South Asians (2.26 [1.48-3.44]), slightly smaller in Chinese (1.32 [1.08-1.62]) and Filipino (1.31 [1.08-1.60]), and similar in Japanese (1.44 [1.15-1.81]) individuals. Heterogeneity in this association across Asian subgroups may be related to type 2 diabetes severity. Understanding this heterogeneity may inform prevention strategies to prevent dementia for all racial and ethnic groups.
摘要：
亚裔美国人的痴呆症发病率低于白人，尽管2型糖尿病患病率较高，众所周知的痴呆危险因素.痴呆的决定因素,包括2型糖尿病,很少在亚裔美国人身上进行研究。我们跟踪了4846个中国人，4,129菲律宾人，2,784日本人,820南亚，从2002年至2020年，以及位于加利福尼亚的综合医疗保健提供系统的123,360名非拉丁裔白人成员。我们通过种族/民族和2型糖尿病状态估计痴呆发病率，并符合Cox比例风险和Aalen加性风险模型，用于2型糖尿病（基线前5年评估）对痴呆诊断年龄的影响，控制性别/性别，教育程度,耶稣诞生,高度,种族/民族,和种族/民族*糖尿病相互作用。2型糖尿病与白人痴呆发病率较高相关(风险比[HR]1.46,95%置信区间[CI]1.40-1.52)。与白人相比,南亚人糖尿病的估计影响更大（2.26[1.48-3.44]），中文（1.32[1.08-1.62]）和菲律宾语（1.31[1.08-1.60]）略小，在日本(1.44[1.15-1.81])个人中也是如此。亚洲亚组之间这种关联的异质性可能与2型糖尿病严重程度有关。了解这种异质性可能会为所有种族和族裔群体提供预防痴呆症的预防策略。
