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

周福凯; 谭伟; 刘丹; 程桂荣; 许浪; 廉鹏飞; 杨萌柳; 余亚夫; 张晶晶; 曾燕

doi:10.16462/j.cnki.zhjbkz.2023.06.002

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

doi: 10.16462/j.cnki.zhjbkz.2023.06.002

周福凯¹,
谭伟²,
刘丹¹,
程桂荣¹,
许浪¹,
廉鹏飞¹,
杨萌柳¹,
余亚夫¹,
张晶晶¹,
曾燕^{1, 2, ,}

1.
武汉科技大学医学院，武汉科技大学脑科学先进技术研究院，武汉 430065
2.
武汉科技大学附属老年病医院神经内科，武汉 430065

基金项目:

国家重点研发计划 2020YFC2006000

国家自然科学基金 72174159

详细信息

通讯作者:
曾燕，E-mail: zengyan68@wust.edu.cn

中图分类号: R181.2
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- 被引次数: 0
出版历程
- 收稿日期: 2022-11-07
- 修回日期: 2023-02-09
- 网络出版日期: 2023-07-10
- 刊出日期: 2023-06-10

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

1.
Medical College, Wuhan University of Science and Technology, Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, Wuhan 430065, China
2.
Neurology Department Geriatric Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430065, China

Funds:

National Key Research and Development Program of China 2020YFC2006000

National Natural Science Foundation of China 72174159

More Information

Corresponding author: ZENG Yan, E-mail: zengyan68@wust.edu.cn

摘要

摘要: 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8 221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。
- 社区老年人 /
- 多病共患 /
- 痴呆患病率 /
- 湖北老年记忆队列 /
- 危险因素
Abstract: 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 8 221 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.
- Community elderly /
- Multimorbidity /
- Prevalence of dementia /
- Hubei memory and aging cohort study /
- Risk factor

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图 1 研究流程图

Figure 1. Flowchart of the study

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表 1 参与者的基本特征[人数(占比/%)]

Table 1. General characteristics of participants (population/%)

特征	总人群(n=8 221)				城市人群(n=5 057)				农村人群(n=3 164)
特征	痴呆人数/个 (n=595)	非痴呆人数/个 (n=7 626)	χ²/Z值	P值	痴呆人数/个 (n=222)	非痴呆人数/个 (n=4 835)	χ²/Z值	P值	痴呆人数/个 (n=373)	非痴呆人数/个 (n=2 791)	χ²/Z值	P值
性别/女性	367(61.68)	4 082(53.52)	14.78	< 0.001	130(58.55)	2 628(54.35)	1.51	0.219	237(63.53)	1 454(52.09)	17.32	< 0.001
年龄组/岁			282.23	< 0.001 ^①							76.00	< 0.001 ^①
65~＜70	114(19.16)	3 327(43.63)			28(12.61)	2 156(44.59)	294.28	< 0.001 ^①	86(23.06)	1 171(41.96)
70~＜75	166(27.90)	2 282(29.92)			37(16.67)	1 401(28.98)			129(34.58)	881(31.57)
75~＜80	124(20.84)	1 168(15.32)			44(19.82)	687(14.21)			80(21.45)	481(17.23)
≥80	191(32.10)	849(11.13)			113(50.90)	591(12.22)			78(20.91)	258(9.24)
文化程度			138.34	< 0.001 ^①							8.55	0.036 ^①
小学及以下	382(64.20)	3 043(39.90)			84(37.84)	963(19.92)	41.92	< 0.001 ^①	298(79.89)	2 080(74.53)
初中	105(17.65)	1 850(24.26)			54(24.32)	1 454(30.07)			51(13.67)	396(14.19)
高中	57(9.58)	1 426(18.70)			38(17.12)	1 176(24.32)			19(5.10)	250(8.96)
大学及以上	51(8.57)	1 307(17.14)			46(20.72)	1 242(25.69)			5(1.34)	65(2.32)
婚姻状况/未婚	243(40.84)	1 709(22.41)	103.54	< 0.001	91(40.99)	832(17.20)	80.47	< 0.001	152(40.75)	877(31.42)	13.05	< 0.001
吸烟/是	148(24.87)	2 177(28.54)	3.67	0.055	54(24.32)	1 323(27.36)	0.99	0.320	94(25.20)	854(30.59)	4.57	0.033
饮酒/是	141(23.69)	1 914(25.09)	0.58	0.447	48(21.62)	1 090(22.54)	0.10	0.748	93(24.93)	824(29.52)	3.37	0.066
体育锻炼/否	223(37.47)	1 310(17.17)	149.95	< 0.001	70(31.53)	598(12.36)	68.00	< 0.001	153(41.01)	712(25.51)	39.84	< 0.001
智力活动/否	412(69.24)	2 865(37.56)	231.00	< 0.001	128(57.65)	1 278(26.43)	103.10	< 0.001	284(76.13)	1 587(56.86)	50.60	< 0.001
BMI肥胖/是	51(8.57)	785(10.29)	1.79	0.181	21(9.45)	479(9.90)	0.05	0.827	30(8.04)	306(10.96)	2.96	0.085
高血压/是	417(70.08)	5 023(65.86)	4.39	0.036	161(72.52)	3 101(64.13)	6.52	0.011	256(68.63)	1 922(68.86)	0.08	0.829
糖尿病/是	110(18.48)	1 257(16.48)	1.60	0.206	55(24.77)	859(17.76)	7.04	0.008	55(14.74)	398(14.26)	0.06	0.802
冠心病/是	97(16.30)	1 091(14.30)	1.78	0.182	48(21.62)	701(14.49)	8.54	0.003	49(13.13)	390(13.97)	0.19	0.661
脑血管病/是	129(21.68)	1 311(17.19)	7.70	0.006	59(26.57)	904(18.69)	8.55	0.003	70(18.76)	407(14.58)	5.50	0.021
共患病情况
否	387(65.04)	5 432(71.23)	10.22	0.001	128(57.66)	3 387(70.05)	15.38	< 0.001	259(69.44)	2 045(73.27)	3.67	0.055
是	208(35.96)	2 194(28.77)			94(42.34)	1 448(29.95)			114(30.56)	746(26.73)
注：①表示采用秩和检验。

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表 2 城乡人群痴呆患病率

Table 2. Prevalence of dementia in urban and rural population

分组	粗患病率 (95% CI)/%	标化患病率 (95% CI)/%
总人群
合计	7.23(6.67~7.79)	7.06(6.40~7.72)
共患病组	8.65(7.53~9.78)	8.58(7.86~9.31)
无共患病组	6.65(6.01~7.29)	6.51(5.87~7.14)
城市人群
合计	4.39(3.82~4.95)	4.34(3.81~4.87)
共患病组	6.09(4.90~7.29)	6.11(5.49~6.73)
无共患病组	3.64(3.02~4.26)	3.48(3.00~3.95)
农村人群
合计	11.78(10.66~12.91)	11.53(10.70~12.35)
共患病组	13.25(10.98~15.52)	12.90(12.03~13.76)
无共患病组	11.24(9.95~12.53)	11.08(10.27~11.89)

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表 3 城乡人群痴呆危险因素logistic回归分析模型分析

Table 3. Logistic regression analysis of risk factors for dementia in urban and rural populations

变量	总人群		城市人群		农村人群
变量	OR值(95% CI)	P值	OR值(95% CI)	P值	OR值(95% CI)	P值
共患病情况
有	1.299(1.079~1.563)	0.006	1.380(1.028~1.854)	0.032	1.195(0.936~1.525)	0.153
无	1.000		1.000		1.000
性别
女	1.398(1.178~1.659)	< 0.001	1.053(0.716~1.550)	0.793	1.619(1.197~2.188)	0.002
男	1.000		1.000		1.000
年龄/岁
70~＜75	1.839(1.433~2.360)	< 0.001	1.913(1.159~3.158)	0.011	1.796(1.342~2.404)	< 0.001
75~＜80	2.642(2.010~3.473)	< 0.001	4.523(2.739~7.469)	< 0.001	2.082(1.495~2.898)	< 0.001
≥80	5.324(4.095~6.923)	< 0.001	11.173(7.014~17.798)	< 0.001	3.526(2.482~5.010)	< 0.001
65~＜70	1.000		1.000		1.000
文化程度
小学及以下	1.848(1.329~2.571)	< 0.001	1.342(0.878~2.052)	0.174	0.904(0.351~2.329)	0.835
初中	1.582(1.107~2.262)	0.012	1.361(0.880~2.105)	0.166	1.349(0.510~3.509)	0.546
高中	1.009(0.697~1.506)	0.964	0.941(0.591~1.498)	0.798	0.824(0.292~2.329)	0.715
大学及以上	1.000		1.000		1.000
婚姻状况
未婚	1.305(1.077~1.581)	0.007	1.451(1.039~2.027)	0.029	1.175(0.929~1.486)	0.177
已婚	1.000		1.000		1.000
吸烟
是	0.913(0.703~1.188)	0.499	0.898(0.589~1.370)	0.619	0.911(0.653~1.272)	0.584
否	1.000		1.000		1.000
饮酒
是	0.890(0.701~1.131)	0.341	0.776(0.517~1.166)	0.222	0.992(0.739~1.330)	0.955
否	1.000		1.000		1.000
体育锻炼
否	1.781(1.473~2.153)	< 0.001	1.867(1.346~2.589)	< 0.001	1.663(1.313~2.107)	< 0.001
是	1.000		1.000		1.000
智力活动
否	2.521(2.063~3.082)	< 0.001	2.942(2.177~3.974)	< 0.001	1.886(1.436~2.478)	< 0.001
是	1.000		1.000		1.000
肥胖
是	0.923(0.678~1.258)	0.613	1.008(0.617~1.647)	0.974	0.794(0.530~1.189)	0.263
否	1.000		1.000		1.000

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