文章摘要
吴晓光,汤哲,方向华,关绍晨,刘红军,刁丽军,孙菲.北京城乡老年队列中基线痴呆的全死因死亡率及死亡风险研究[J].中华流行病学杂志,2011,32(10):973-977
北京城乡老年队列中基线痴呆的全死因死亡率及死亡风险研究
A cohort study on mortality and risk of death among population diagnosis as dementia, at base-line survey, in Beijing
收稿日期:2011-03-29  出版日期:2014-09-11
DOI:10.3760/cma.j.issn.0254-6450.2011.10.005
中文关键词: 痴呆;阿尔茨海默病;血管性痴呆;死亡率;队列研究
英文关键词: Dementia;Alzheimer' s disease;Vascular dementia;Mortality;Cohort study
基金项目:
作者单位E-mail
吴晓光 首都医科大学宣武医院流行病学和社会医学部教育部神经变性病重点实验室, 北京 100053  
汤哲 首都医科大学宣武医院流行病学和社会医学部教育部神经变性病重点实验室, 北京 100053 tangzhe@medmail.com.cn 
方向华 首都医科大学宣武医院流行病学和社会医学部教育部神经变性病重点实验室, 北京 100053  
关绍晨 首都医科大学宣武医院流行病学和社会医学部教育部神经变性病重点实验室, 北京 100053  
刘红军 首都医科大学宣武医院流行病学和社会医学部教育部神经变性病重点实验室, 北京 100053  
刁丽军 首都医科大学宣武医院流行病学和社会医学部教育部神经变性病重点实验室, 北京 100053  
孙菲 首都医科大学宣武医院流行病学和社会医学部教育部神经变性病重点实验室, 北京 100053  
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中文摘要:
      目的 通过对目标人群的追踪观察,探讨老年期痴呆的死亡率及死亡风险。方法 1997年采用按类分层、分阶段随机抽取区(县)、街道(乡)、居委会(自然村),按照整群抽样原则获得研究样本。分两阶段调查基线痴呆患病率,第一阶段完成问卷调查及筛查量表(MMSE)等测试,第二阶段由神经内科医师对MMSE得分低于界值和部分正常的老年人进行病史搜集、临床查体及神经心理测验等,最后由2名神经内科医师根据DSM-Ⅲ-R和NINCDS-ADRDA等诊断标准完成痴呆的临床诊断。最终获得有效调查样本2788例。在2000和2004年对研究样本进行全面随访同时记录死亡及失访原因和时间,总计随访7.25年。结果 基线共诊断痴呆171例,累积死 亡133人。全样本的痴呆粗死亡率和年龄标化率分别为7.8/1000人年和5.5/1000人年,且随年龄的增加而呈指数增加;痴呆组其粗死亡率和年龄标化率分别为236/1000人年和206/1000人年;非痴呆组累积死亡680人,粗死亡率和年龄标化率分别为40/1000人年和31/1000人年,两组粗死亡率差异有统计学意义。痴呆的死亡风险比在60~74岁各组均高于≥75岁各组。经多因素Cox回归调整,痴呆的死亡风险比为2.181(95%CI:1.751~2.717)、阿尔茨海默病为2.524(95%CI:1.964~ 3.243)、血管性痴呆为1.859(95%CI:1.213~2.850)。结论 老年期痴呆的粗死亡率及死亡风险比大大高于一般人群,提示痴呆是预示老年人死亡的最主要危险因素之一。
英文摘要:
      To study the mortality and risk of death on dementia among ageing population. Methods A random sample including 2788 elderly residents was studied. Dementia was diagnosed under the two-phase procedure in 1997. In phase 1, questionnaire was administered, including the Mini-Mental State Examination (MMSE) tested. In phase 2, all the elderly who showed low MMSE score and some with normal MMSE score, were examined by neurologists. The clinical diagnosis of dementia was set up by two neurologists according to the criteria of DSM- Ⅲ -R and NINCDS-ADRDA. The same sample was followed up in 2000 and 2004 the same way and data on deaths and causes was gathered. The overall time for follow-up was 7.25 years. Results 171 cases with dementia were diagnosed from 2788 subjects in 1997, with a crude death rate(CDR) of dementia was 7.8 per 1000 person-years and age-standardized CDR as 5.5 per 1000 person-years. The death rate was increased exponentially with age. In the dementia group, the total number of deaths was 133, with the CDR as 236 per 1000 person-years and the age-standardized CDR as 206 per 1000 person-years, in the end of the survey. In the non-dementia group, the total number of deaths was 680, with CDR as 40 per 1000 person-years and the age-standardized CDR as 31 per 1000 person-years. The difference in the two groups was statistically significant. The hazard ratio (HR) of dementia death appeared to be the biggest in the 60-74-year group than the other groups. Data was analyzed with the Cox proportional hazards model after making necessary adjustment on potential covariates with the HR of dementia as 2.181 (95%CI: 1.751-2.717). The HRs were 2.524 (95%CI1.964-3.243) in Alzheimer's disease and 1.859 (95% CI: 1.213-2.850) in vascular dementia. Conclusion The CDR and HR of dementia were higher than the non-dementia group in the aging population, showing that dementia was one of the most important risk factors on death in the aging population.
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