自身免疫性疾病和疾病修饰抗风湿药与阿尔茨海默氏症和/或痴呆症风险的关系:使用医疗保险受益人数据的人口研究。

Qian Ding, Jennifer Lamberts, Alison M Konieczny, Tyler B Bringedahl, Kiara Y Torres Garcia
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引用次数: 0

摘要

目标:阿尔茨海默病(AD)和/或痴呆症是一种普遍的神经认知障碍疾病,主要影响 65 岁以上的老年人。确定阿兹海默病和/或痴呆症的具体病因具有挑战性,新出现的证据表明阿兹海默病和/或痴呆症可能与类风湿性关节炎(RA)等自身免疫性炎症有关。本研究旨在评估在报告患有自身免疫性疾病的医疗保险受益人中,注意力缺失症和/或痴呆症的患病率。此外,本研究还试图确定使用改变病情抗风湿药(DMARDs)的自身免疫性疾病患者与未使用DMARDs的患者中注意力缺失症和/或痴呆症患病率的比较:对2017年和2018年的医疗保险当前受益人调查(MCBS)数据进行了横断面二级数据分析。MCBS数据由具有全国代表性的医疗保险人群样本组成,该人群大多为65岁及以上的老年人,并提供去标识化的患者信息。该数据集中有自述自身免疫性疾病的患者被纳入分析范围。对人口统计学变量、慢性病和药物使用情况进行了描述性分析。对患有和未患有自身免疫性疾病的患者的注意力缺失症和/或痴呆症患病率进行了比较。采用逆向逐步选择回归法确定与注意力缺失症和/或痴呆症患病率相关的风险因素:研究纳入了 18929 名医疗保险受益人,其中 4405 人被确认患有一种自身免疫性疾病。患有自身免疫性疾病的患者中,注意力缺失症和/或痴呆症的患病率明显较高。多变量回归结果显示,RA 与注意力缺失症和/或痴呆症的高风险有明显关联。其他人口统计学因素,包括高龄、非裔美国人或西班牙裔、低体重指数,以及缺血性心脏病、心肌梗死史、中风史、抑郁症、精神疾病和脑外伤等慢性疾病,也与注意力缺失症和/或痴呆症有显著的统计学关联。与不使用DMARDs的患者相比,使用DMARDs的患者患AD和/或痴呆症的可能性较低:本研究提供了RA与AD和/或痴呆症风险增加之间存在关联的证据。研究结果表明,使用DMARD可能对自身免疫性疾病患者的AD和/或痴呆症的发展具有保护作用。
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Association of Autoimmune Disorders and Disease-modifying Antirheumatic Drugs: (DMARDs) with the Risk of Alzheimer's and/or Dementia: A Population Study Using Medicare Beneficiary Data.

Objectives: Alzheimer's disease (AD) and/or dementia is a prevalent neurocognitive disorder primarily affecting individuals over the age of 65. Identifying specific causes of AD and/or dementia can be challenging, with emerging evidence suggesting a potential association with autoimmune inflammatory conditions such as rheumatoid arthritis (RA). This study aimed to assess the prevalence rate of AD and/or dementia among Medicare beneficiaries reporting an autoimmune disorder. Additionally, this study sought to identify the comparative prevalence of AD and/or dementia in patients with an autoimmune disorder who were using disease-modifying antirheumatic drugs (DMARDs) compared to those not using DMARDs.

Methods: Cross-sectional secondary data analyses were conducted on Medicare Current Beneficiary Survey (MCBS) data from 2017 and 2018. The MCBS data consists of a nationally representative sample of the Medicare population, a population that is largely 65 and older, and provides de-identified patient information. Patients from this dataset with a self-reported autoimmune disorder were included in the analyses. Descriptive analyses were conducted on demographic variables, chronic conditions, and medication use. The prevalence of AD and/or dementia was compared between patients with and without an autoimmune disorder. A backward stepwise selection regression was used to identify the risk factors associated with the prevalence of AD and/or dementia.

Results: The study included 18,929 Medicare beneficiaries, with 4,405 identified as having one autoimmune disorder. The prevalence of AD and/or dementia was significantly higher in patients with an autoimmune disorder. The multivariate regression showed that RA was significantly associated with a higher risk of AD and/or dementia. Other demographic factors, including advanced age, African-American or Hispanic ethnicity, low body mass index, and chronic conditions of ischemic heart disease, history of myocardial infarction, history of stroke, depression, mental health disorder(s), and traumatic brain injury also showed statistically significant associations with AD and/or dementia. Patients using DMARDs demonstrated a reduced likelihood of having AD and/or dementia, compared to patients not using DMARDs.

Conclusion: This study provides evidence of an association between RA and increased risk of AD and/or dementia. The findings suggest that DMARD use may have a protective effect against the development of AD and/or dementia in patients with an autoimmune disorder.

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