有无哮喘的阿尔茨海默症的发病率和患病率：一项医疗保险队列研究
2024/05/28
摘要
背景：国际数据表明，哮喘和其他炎症性疾病一样，可能会增加阿尔茨海默病（AD）的风险。
目的：通过比较美国哮喘患者和非哮喘患者的诊断性AD发病率和患病率，探索风险途径和未来的缓解策略。
方法：这项队列研究包括2013-2015年国家医疗保险20%随机样本。将连续医疗保险超过12个月的成年哮喘患者与非哮喘患者进行总体和匹配比较。哮喘由一个或两个哮喘门诊代码定义。主要结局是两年内事件或流行性AD，定义为ICD-9 331.0或ICD-10 G30.0、G30.1、G30.8、G30.9的任何代码。
结果：在5,460,732名受益人中，有678,730名患者被确定为基线哮喘，且黑人或西班牙裔患者、符合医疗补助条件的患者或居住在极度贫困社区的患者比没有哮喘的患者更常见。两年内，哮喘患者的AD发病率为1.4%，而非哮喘患者的AD发病率为1.1%；患病率为7.8%，而非哮喘患者的患病率为5.4%（两者均p<0.001）。两年内，每100,000名患者中，哮喘患者AD发病多303例，患病多2,425例（p<0.001）。多变量模型显示，哮喘患者两年内AD发病率[AOR 1.33 (1.29-1.36)；匹配1.2 (1.17-1.24)]和患病率[AOR 1.48 (1.47-1.50)；匹配1.25 (1.22-1.27)]的可能性更大。
结论：在美国这一具有全国代表性的样本中，哮喘与两年内发病率增加20-33%和基于索赔的阿尔茨海默病患病率增加25-48%有关。未来的研究应调查潜在合并症和社会决定因素的风险途径，以及是否存在可能保护大脑健康的潜在哮喘治疗方法。
Alzheimer's Incidence and Prevalence with and without Asthma: A Medicare cohort study
Christie M Bartels, Yi Chen, W Ryan Powell, Melissa A Rosenkranz, Barbara B Bendlin, Joseph Kramer, William W Busse, Amy Kind
Abstract
Background: International data suggest that asthma, like other inflammatory diseases, might increase Alzheimer's disease (AD) risk.
Objective: To explore risk pathways and future mitigation strategies by comparing diagnostic claims-based AD incidence and prevalence among US patients with asthma to non-asthma patients.
Methods: This cohort study included a national Medicare 20% random sample 2013-2015. Adult patients with >12 months continuous Medicare with asthma were compared to non-asthma subjects overall and as matched. Asthma was defined by one inpatient or two outpatient codes for asthma. The main outcomes were two-year incident or prevalent AD defined as any codes for ICD-9 331.0 or ICD-10 G30.0, G30.1, G30.8, G30.9.
Results: Among 5,460,732 total beneficiaries, 678,730 patients were identified with baseline asthma and more often identified as Black or Hispanic, were Medicaid eligible, or resided in a highly disadvantaged neighborhood than those without asthma. Two-year incidence of AD was 1.4% with asthma vs 1.1% without; prevalence was 7.8% vs 5.4% (both p=<0.001). Per 100,000 patients over two years, 303 more incident AD diagnoses occurred in asthma, with 2,425 more prevalent cases (p<0.001). Multivariable models showed asthma had greater odds of two-year AD incidence [AOR 1.33 (1.29-1.36); matched 1.2 (1.17-1.24)] and prevalence [AOR 1.48 (1.47-1.50); matched 1.25 (1.22-1.27)).
Conclusion: Asthma was associated with 20-33% increased two-year incidence and 25-48% increased prevalence of claims-based Alzheimer's disease in this nationally representative US sample. Future research should investigate risk pathways of underlying comorbidities and social determinants, as well as whether there are potential asthma treatments that may preserve brain health.
背景：国际数据表明，哮喘和其他炎症性疾病一样，可能会增加阿尔茨海默病（AD）的风险。
目的：通过比较美国哮喘患者和非哮喘患者的诊断性AD发病率和患病率，探索风险途径和未来的缓解策略。
方法：这项队列研究包括2013-2015年国家医疗保险20%随机样本。将连续医疗保险超过12个月的成年哮喘患者与非哮喘患者进行总体和匹配比较。哮喘由一个或两个哮喘门诊代码定义。主要结局是两年内事件或流行性AD，定义为ICD-9 331.0或ICD-10 G30.0、G30.1、G30.8、G30.9的任何代码。
结果：在5,460,732名受益人中，有678,730名患者被确定为基线哮喘，且黑人或西班牙裔患者、符合医疗补助条件的患者或居住在极度贫困社区的患者比没有哮喘的患者更常见。两年内，哮喘患者的AD发病率为1.4%，而非哮喘患者的AD发病率为1.1%；患病率为7.8%，而非哮喘患者的患病率为5.4%（两者均p<0.001）。两年内，每100,000名患者中，哮喘患者AD发病多303例，患病多2,425例（p<0.001）。多变量模型显示，哮喘患者两年内AD发病率[AOR 1.33 (1.29-1.36)；匹配1.2 (1.17-1.24)]和患病率[AOR 1.48 (1.47-1.50)；匹配1.25 (1.22-1.27)]的可能性更大。
结论：在美国这一具有全国代表性的样本中，哮喘与两年内发病率增加20-33%和基于索赔的阿尔茨海默病患病率增加25-48%有关。未来的研究应调查潜在合并症和社会决定因素的风险途径，以及是否存在可能保护大脑健康的潜在哮喘治疗方法。
(中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(J Allergy Clin Immunol. 2024 Apr 24:S0091-6749(24)00406-8. doi: 10.1016/j.jaci.2024.04.008.)
(J Allergy Clin Immunol. 2024 Apr 24:S0091-6749(24)00406-8. doi: 10.1016/j.jaci.2024.04.008.)
Alzheimer's Incidence and Prevalence with and without Asthma: A Medicare cohort study
Christie M Bartels, Yi Chen, W Ryan Powell, Melissa A Rosenkranz, Barbara B Bendlin, Joseph Kramer, William W Busse, Amy Kind
Abstract
Background: International data suggest that asthma, like other inflammatory diseases, might increase Alzheimer's disease (AD) risk.
Objective: To explore risk pathways and future mitigation strategies by comparing diagnostic claims-based AD incidence and prevalence among US patients with asthma to non-asthma patients.
Methods: This cohort study included a national Medicare 20% random sample 2013-2015. Adult patients with >12 months continuous Medicare with asthma were compared to non-asthma subjects overall and as matched. Asthma was defined by one inpatient or two outpatient codes for asthma. The main outcomes were two-year incident or prevalent AD defined as any codes for ICD-9 331.0 or ICD-10 G30.0, G30.1, G30.8, G30.9.
Results: Among 5,460,732 total beneficiaries, 678,730 patients were identified with baseline asthma and more often identified as Black or Hispanic, were Medicaid eligible, or resided in a highly disadvantaged neighborhood than those without asthma. Two-year incidence of AD was 1.4% with asthma vs 1.1% without; prevalence was 7.8% vs 5.4% (both p=<0.001). Per 100,000 patients over two years, 303 more incident AD diagnoses occurred in asthma, with 2,425 more prevalent cases (p<0.001). Multivariable models showed asthma had greater odds of two-year AD incidence [AOR 1.33 (1.29-1.36); matched 1.2 (1.17-1.24)] and prevalence [AOR 1.48 (1.47-1.50); matched 1.25 (1.22-1.27)).
Conclusion: Asthma was associated with 20-33% increased two-year incidence and 25-48% increased prevalence of claims-based Alzheimer's disease in this nationally representative US sample. Future research should investigate risk pathways of underlying comorbidities and social determinants, as well as whether there are potential asthma treatments that may preserve brain health.
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严重哮喘生物疗法的安全性：WHO药物警戒数据库中报告的疑似不良反应分析
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症状特征、知觉因果归因及影响自我照顾行为的环境因素:慢性疾病成人生态日常评估研究
