Abstract
BackgroundCurrent knowledge about incident dementia is mainly derived from studies undertaken in the West, showing that dementia is related to older age, low socio-economic status, lack of social network, depression and cardiovascular disease risk factors. We know little about incidence and predictors of dementia in China, where the prevalence is increasing and the patterns of risk factors are different.MethodsUsing a standard interview method, we examined 1526 non-demented people aged ≥65 years who had at least minimal educational level in China in a 7.5-year follow up. Incident dementia was diagnosed by GMS-AGECAT algorithms and psychiatrists.ResultsAge-standardised incidence of dementia was 14.7 per 1000 person-years (95%CI 11.3–18.2 per 1000 person-years). The increased risk was significantly associated with age, female gender (adjusted odds ratio 2.48, 95%CI 1.20–5.13), low educational levels, smoking, angina (2.58, 1.01–6.59) and living with fewer family members. Among participants with low educational level, the increased risk was associated with higher income, and with the highest and lowest occupational classes; adjusted odds ratio 2.74 (95%CI 1.12–6.70) for officers/teachers, 3.11 (1.61–6.01) for manual labourers/peasants.ConclusionsOur findings of high incidence of dementia and increased risk among people having low education levels but high income suggest a more potential epidemic and burden of dementia populations in China. Maintaining social network and activities and reducing cardiovascular factors in late life could be integrated into current multi-faceted preventive strategies for curbing the epidemic of dementia.
Highlights
Dementia is a major public health challenge, becoming more common as the global population ages
Studies in the West have shown that dementia is related to older age, low educational levels, high cardiovascular disease risk factors,[2] and depression. [3,4] In many western populations, low socioeconomic status, high cardiovascular risk factors and depression tend to co-occur,[5] making their individual contribution to the cause of dementia difficult to unravel
Up to 7.5 years follow up, there was a total of 5083.1 person-years at risk (PYARs) and 80 cases of dementia occurred (63 dementia diagnoses from Geriatric Mental State (GMS)-Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT), 15 from psychiatrists and 2 from the underlying causes of death)
Summary
Dementia is a major public health challenge, becoming more common as the global population ages. [6] By contrast with western populations, older people in China exhibit different patterns of risk factor clustering with extremes of absolute deprivation [6] combined with high levels of social support, [7] low levels of depression [8,9] and low levels of cardiovascular disease risk factors (e.g. body mass index) except high blood pressure. Studying such a population will offer insights applicable to the aetiology and prevention of dementia. We know little about incidence and predictors of dementia in China, where the prevalence is increasing and the patterns of risk factors are different
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