Association between socioeconomic status and mild cognitive impairment in community-living older adults
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摘要:
目的 探讨老年人社会经济地位(socioeconomic status，SES)与轻度认知功能障碍(mild cognitive impairment，MCI)患病的关联。 方法 数据来源于湖北老年记忆队列(the Hubei Memory and Aging Cohort Study，HMACS)；共纳入7 887名≥65岁老年人，他们完成了3全套神经心理评估和临床体格检查。SES通过受教育程度、职业性质和家庭人均月收入综合评定；MCI由专家组根据Petersen标准和中国痴呆与认知障碍诊治指南进行诊断；多因素logistic回归分析模型分析老年人SES与MCI患病的关联。 结果 共纳入7 887名调查对象，平均年龄(71.74±5.58)岁，MCI检出率为23.00%(95% CI: 22.07%~23.93%)；低SES组MCI检出率(44.65%)高于中SES组MCI检出率(16.89%)和高SES组MCI检出率(9.18%)；女性高于男性；农村高于城市。分层分析发现：城市男性低SES组MCI患病风险为高SES组的6.276倍(OR=6.276, 95% CI: 4.017~9.805)，城市女性低SES组MCI患病风险为高SES组的3.978倍(OR=3.978, 95% CI: 2.943~5.376)；依据现有SES标准，农村女性老年人SES分布不均匀。 结论 低SES组老年人MCI检出率较高，认知功能障碍的防控要密切关注低SES组老年人，特别是社区低收入、低教育程度的老年人。 Abstract:Objective To explore the relationship between socioeconomic status (SES) and mild cognitive impairment (MCI) in older adults. Methods We utilzed the data from the Hubei Memory and Aging Cohort Study (HMACS). A total of 7 787 older adults ≥65 years old were included, who had completed a complete set of neuropsychological assessments and clinical physical examinations. SES was measured by factors such as education level, occupation, and monthly household income per capita. MCI was diagnosed by a panel of experts following Petersen′s MCI standard and Chinese Diagnostic guidelines for dementia and Cognitive impairment. A multivariate logistic regression was used to analyze the association between SES and MCI in older adults. Results Out of the 7 887 respondents (average age of 71.74±5.58 years), the prevalence of MCI was 23.00% (95% CI: 22.07%-23.93%). MCI prevalence was highest among the low SES group at 44.65%, followed by the middle SES group (16.89%) and the high SES group (9.18%); it was more prevalent among women than men, and more common in rural areas compared to urban ones. Stratified analysis revealed that, compared to their high SES counterparts, the risk of MCI was 6.276 times higher among low SES urban males (OR=6.276, 95% CI: 4.017-9.805) and 3.978 times higher among low SES urban females (OR=3.978, 95% CI: 2.943-5.376). Among rural female older adults, the distribution of SES was significantly uneven according to existing SES standards. Conclusions Older adults with lower SES have a higher prevalence of MCI. Therefore, MCI prevention strategies should particularly focus on community-dwelling older adults with lower income and educational attainment. -
表 1 调查人群的基本情况
Table 1. Basic information of the participants
变量 Variable SES[人数(占比/%)]
SES [Number of people (proportion /%)]低 Low
(n=2 383)中 Middle
(n=3 173)高 High
(n=2 331)χ2/Z值
valueP值
value性别 Gender 52.104 < 0.001 男 Male 994(41.71) 1 466(46.20) 1 216(52.17) 女 Female 1 389(58.29) 1 707(54.80) 1 115(47.83) 年龄/岁, (x±s) Age /years, (x±s) 72.02±5.43 71.17±5.48 72.22±5.81 87.907 < 0.001 居住地 Region 3 131.978 < 0.001 城市 Urban 679(28.49) 2 609(82.23) 2 297(98.54) 农村 Rural 1 704(71.51) 564(17.77) 34(1.46) 婚姻状况 Marital status 629.937 < 0.001 有配偶 Married 1 264(53.04) 2 119(66.78) 2 023(86.79) 无配偶 Mateless 1 119(46.96) 1 054(33.22) 308(13.21) 吸烟 Smoking 5.586 0.061 是 Yes 753(31.60) 955(30.10) 663(28.44) 否 No 1 630(68.40) 2 218(69.90) 1 668(71.56) 饮酒 Drinking 261.413 < 0.001 是 Yes 1 021(42.85) 811(25.56) 550(23.60) 否 No 1 362(57.15) 2 362(74.44) 1 781(76.40) 体育锻炼 Physical activity 502.804 < 0.001 是 Yes 1 566(66.10) 2 726(85.94) 2 087(89.53) 否 No 803(33.90) 446(14.06) 244(10.47) 智力活动 Intellectual activity 1 019.457 < 0.001 是 Yes 901(37.90) 2 140(68.28) 1 894(81.46) 否 No 1 476(62.10) 994(31.72) 431(18.54) 高血压 Hypertension 4.754 0.093 是 Yes 1 431(60.05) 1 973(62.18) 1 469(63.02) 否 No 952(39.95) 1 200(37.82) 862(36.98) 糖尿病 Diabetes 38.418 < 0.001 是 Yes 307(12.88) 557(17.55) 451(19.35) 否 No 2 076(87.12) 2 616(82.45) 1 880(80.65) 冠心病 Coronary heart disease 6.989 0.030 是 Yes 385(16.16) 447(14.09) 382(16.39) 否 No 1 988(83.84) 2 726(85.91) 1 949(83.61) 脑血管病 Cerebral vascular disease 6.273 0.043 是 Yes 459(19.26) 565(17.81) 477(20.46) 否 No 1 924(80.74) 2 608(82.19) 1 854(79.54) 向心性肥胖 Central obesity 40.458 < 0.001 是 Yes 1 729(72.56) 2 106(66.37) 1 499(64.31) 否 No 654(27.44) 1 067(33.63) 832(35.69) 抑郁 Depressed 10.890 0.004 是 Yes 115(4.83) 105(3.31) 76(3.26) 否 No 2 268(95.17) 3 068(96.69) 2 255(96.74) 失眠 Insomnia 205.092 < 0.001 是 Yes 1 550(65.04) 1 627(51.28) 1 044(44.79) 否 No 833(34.96) 1 546(48.72) 1 287(55.21) MCI 948.872 < 0.001 是 Yes 1 064(44.65) 536(16.89) 214(9.18) 否 No 1 319(55.35) 2 637(83.11) 2 117(90.82) 注: 1. 15人在体育锻炼方面信息缺失，51人在智力活动习惯方面信息缺失。
2. MCI, 轻度认知功能障碍; SES, 社会经济地位。
Notes: 1. Fifteen people lacked information on physical exercise and 51 people lacked information on intellectual activity habits.
2. MCI, mild cognitive impairment; SES, socioeconomic status.
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表 2 不同SES组老年人MCI检出率的城乡、性别差异
Table 2. Differences in the prevalence of MCI among older adults in different SES groups with regard to urban-rural and gender disparities
变量 Variable MCI 男 Male 女 Female 患病率/%
Prevalence/%患病率(95% CI)/%
Prevalence(95% CI)/%χ2值
valueP值
value患病率/%
Prevalence/%患病率(95% CI)/%
Prevalence(95% CI)/%χ2值
valueP值
value农村 SES Rural SES 低 Low 41.26 37.79~44.73 / / 54.54 51.32~57.75 / / 中 Middle 31.88 27.09~36.67 9.288 0.002 42.64 35.67~49.61 9.217 0.002 高 High 18.52 2.86~34.18 7.386 0.007 // // // // 城市 SES Urban SES 低 Low 34.72 28.32~41.12 / / 35.21 30.84~39.57 / / 中 Middle 11.28 9.41~13.16 77.223 < 0.001 13.97 12.22~15.75 103.976 < 0.001 高 High 7.99 6.45~9.53 486.356 < 0.001 10.11 8.33~11.89 142.429 < 0.001 注：1. “/”表示该组作为参考组; “//”表示农村女性高SES组7人，不满足分析条件。
2. SES, 社会经济地位; MCI, 轻度认知功能障碍。
Notes: 1. "/" indicates that the group serves as a reference group; "//" indicates that there are 7 rural women in the high SES group, which do not meet the analysis conditions.
2. SES, socioeconomic status; MCI, mild cognitive impairment.
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表 3 不同地区及性别老年人SES与MCI患病的关联性
Table 3. Relationship between SES and MCI in older adults of different regions and gender
变量 Variable 男 Male 女 Female P值 value OR值 value 95% CI P值 value OR值 value 95% CI 农村 SES Rural SES 高 High 1.000 // 中 Middle 0.047 2.862 1.013~8.089 1.000 低 Low 0.026 3.208 1.150~8.951 0.002 1.468 1.146~1.880 城市 SES Urban SES 高 High 1.000 中 Middle 0.021 1.425 1.054~1.927 0.003 1.463 1.136~1.885 低 Low < 0.001 6.276 4.017~9.805 < 0.001 3.978 2.943~5.376 注：1. 模型控制了年龄、婚姻状况、饮酒、向心性肥胖、抑郁、失眠、体育锻炼以及智力活动习惯。
2. “//”表示农村女性高SES组7人，不满足分析条件。
3. SES, 社会经济地位; MCI, 轻度认知功能障碍。
Notes: 1. The model adjusting for age, marital status, alcohol consumption, centripetal obesity, depression, insomnia, physical activity, and intellectual activity habits.
2. "//" indicates that there were 7 rural women in the high SES group who did not meet the analysis conditions.
3. SES, socioeconomic status; MCI, mild cognitive impairment.
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