CAJ | 학술논문

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.
목적 통과대목표인군적추종관찰,탐토노년기치태적사망솔급사망풍험.방법 1997년채용안류분층、분계단수궤추취구(현)、가도(향)、거위회(자연촌),안조정군추양원칙획득연구양본.분량계단조사기선치태환병솔,제일계단완성문권조사급사사량표(MMSE)등측시,제이계단유신경내과의사대MMSE득분저우계치화부분정상적노년인진행병사수집、림상사체급신경심리측험등,최후유2명신경내과의사근거DSM-Ⅲ-R화NINCDS-ADRDA등진단표준완성치태적림상진단.최종획득유효조사양본2788례.재2000화2004년대연구양본진행전면수방동시기록사망급실방원인화시간,총계수방7.25년.결과 기선공진단치태171례,루적사망133인.전양본적치태조사망솔화년령표화솔분별위7.8/1000인년화5.5/1000인년,차수년령적증가이정지수증가;치태조기조사망솔화년령표화솔분별위236/1000인년화206/1000인년;비치태조루적사망680인,조사망솔화년령표화솔분별위40/1000인년화31/1000인년,량조조사망솔차이유통계학의의.치태적사망풍험비재60～74세각조균고우≥75세각조.경다인소Cox회귀조정,치태적사망풍험비위2.181(95％CI:1.751～2.717)、아이자해묵병위2.524(95％CI:1.964～3.243)、혈관성치태위1.859(95％CI:1.213～2.850).결론 노년기치태적조사망솔급사망풍험비대대고우일반인군,제시치태시예시노년인사망적최주요위험인소지일.
Objective 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％CI:1.964-3.243) 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.