法国巴黎大学Céline Ben Hassen团队研究了多发病年龄与痴呆发病率之间的相关性。这一研究成果发表在2022年2月2日出版的《英国医学杂志》上。
为了探讨中老年多发病率（包括多发病的严重程度）与偶发性痴呆的相关性，研究组在英国伦敦公务部门（白厅II研究，1985-88年研究开始）进行了一项前瞻性队列研究。共招募了10095名参与者，基线年龄为35至55岁。主要观察指标为1985-2019年随访期间发生的痴呆事件。考虑到死亡的竞争风险，研究组使用病因特异性Cox比例风险回归分析了总体以及55、60、65和70岁时的多发病率与后续痴呆症的相关性。
多发病（≥2种慢性病）患病率55岁时为6.6%（655/9937），70岁时为31.7%（2464/7783）；在31.7年的中位随访期内，共发生639例偶发性痴呆。在对社会人口因素和健康行为进行校正后，55岁的多发病率与随后的痴呆症风险相关，每1000人-年发病率差异为1.56，危险比为2.44。
在多发病开始时，随着年龄的增长，这种关联逐渐减弱。在65岁时，55岁之前多发病与痴呆症发病率每1000人-年增加3.86（危险比为2.46）相关，60-65岁的多发病与痴呆症发病率每1000人-年增加1.85（1.51）相关。55岁之前多发病的严重性（≥3种慢性病）与痴呆症发病率每1000人-年增加5.22相关（危险比为4.96）；在70岁时进行的相同分析显示，每1000人-年的发病率增加4.49（1.65）。
研究结果表明，多发病，尤其是在中年而非晚年发病时，与后续痴呆症有着密切的联系。多病发病的年龄越来越年轻，这使得预防首次患有慢性疾病患者的多病很重要。
附：英文原文
Title: Association between age at onset of multimorbidity and incidence of dementia: 30 year follow-up in Whitehall II prospective cohort study
Author: Céline Ben Hassen, Aurore Fayosse, Benjamin Landré, Martina Raggi, Mikaela Bloomberg, Séverine Sabia, Archana Singh-Manoux
Issue&Volume: 2022/02/02
Abstract:
Objective To examine the association of midlife and late life multimorbidity, including severity of multimorbidity, with incident dementia.
Design Prospective cohort study.
Setting Civil service departments in London (Whitehall II study, study inception in 1985-88).
Participants 10095 participants, aged 35 to 55 at baseline.
Main outcome measure Incident dementia at follow-up between 1985 and 2019. Cause specific Cox proportional hazards regression was used to examine the association of multimorbidity overall and at age 55, 60, 65, and 70 with subsequent dementia, taking into account the competing risk of death.
Results The prevalence of multimorbidity (≥2 chronic diseases) was 6.6% (655/9937) at age 55 and 31.7% (2464/7783) at age 70; 639 cases of incident dementia occurred over a median follow-up of 31.7 years. After adjustment for sociodemographic factors and health behaviours, multimorbidity at age 55 was associated with subsequent risk of dementia (difference in incidence rate per 1000 person years 1.56, 95% confidence interval 0.62 to 2.77; hazard ratio 2.44, 95% confidence interval 1.82 to 3.26). The association weakened progressively with older age at onset of multimorbidity. At age 65, onset of multimorbidity before age 55 was associated with 3.86 (1.80 to 6.52) per 1000 person years higher incidence of dementia (hazard ratio 2.46, 1.80 to 2.26) and onset between 60 and 65 was associated with 1.85 (0.64 to 3.39) per 1000 person years higher incidence (1.51, 1.16 to 1.97). Severity of multimorbidity (≥3 chronic diseases) at age 55 was associated with a 5.22 (1.14 to 11.95) per 1000 person years higher incidence of dementia (hazard ratio 4.96, 2.54 to 9.67); the same analyses at age 70 showed 4.49 (2.33 to 7.19) per 1000 person years higher incidence (1.65, 1.25 to 2.18).
Conclusion Multimorbidity, particularly when onset is in midlife rather than late life, has a robust association with subsequent dementia. The increasingly younger age at onset of multimorbidity makes prevention of multimorbidity in people with a first chronic disease important.
DOI: 10.1136/bmj-2021-068005
Source: https://www.bmj.com/content/376/bmj-2021-068005
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
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本期文章：《英国医学杂志》：Online/在线发表
