佛罗里达心脏病研究队中出生队列分析的痴呆症发病率时间趋势
Temporal Trends in Incidence of Dementia in a Birth Cohorts Analysis of the Framingham Heart Study
AI总结：
佛罗里达心脏病研究队分析显示，痴呆症风险在不同出生队列中无时间下降趋势，女性终身年龄条件风险高于男性。
摘要：
背景：痴呆症导致严重的残疾负担，全球范围内痴呆症患者人数在1990年至2016年间翻了一番。然而，一些研究指出痴呆症风险可能降低，这可能是由于传统分析方法的偏差造成的，这些方法未能充分考虑因死亡导致的疾病信息缺失。 方法：本研究重新审视了佛罗里达心脏病研究队中四十年内痴呆症发病率的潜在趋势。我们应用了一个针对区间删失疾病-死亡数据的多状态建模框架，并定义了三个非重叠的出生队列（1915-1924、1925-1934和1935-1944）。通过痴呆症患病率和痴呆症风险来评估趋势，以年龄作为基础时间尺度。此外，还估计了按性别分层的年龄条件痴呆症概率。 结果：3828名个体中有731人被诊断为痴呆症。多状态模型分析显示，无论性别如何，出生队列中痴呆症风险均无时间下降趋势。当按性别分层并调整教育水平后，女性始终表现出更高的终身年龄条件风险（46%-50%）比男性（30%-34%）。 结论：我们推荐在队列研究中使用多状态方法和出生队列分离的组合，以充分估计疾病风险的趋势，并传达患者相关的结局，如年龄条件的疾病风险。
英文摘要：
Background: Dementia leads to a high burden of disability and the number of dementia patients worldwide doubled between 1990 and 2016. Nevertheless, some studies indicated a decrease in dementia risk which may be due to a bias caused by conventional analysis methods that do not adequately account for missing disease information due to death. Methods: This study re-examines potential trends in dementia incidence over four decades in the Framingham Heart Study. We apply a multistate modeling framework tailored to interval-censored illness-death data and define three non-overlapping birth cohorts (1915-1924, 1925-1934, and 1935-1944). Trends are evaluated based on both dementia prevalence and dementia risk, using age as the underlying timescale. Additionally, age-conditional dementia probabilities stratified by sex are estimated. Results: A total of 731 out of 3828 individuals were diagnosed with dementia. The multistate model analysis revealed no temporal decline in dementia risk across birth cohorts, irrespective of sex. When stratified by sex and adjusted for education, women consistently exhibited higher lifetime age-conditional risks (46%-50%) than men (30%-34%) over the study period. Conclusions: We recommend using a combination of multistate approach and separation into birth cohorts to adequately estimate trends of disease risk in cohort studies as well as to communicate patient-relevant outcomes such age-conditional disease risks.
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