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Dementia is a clinical syndrome characterized by cognitive impairment, which is the leading cause of disability in people aged ≥65 years worldwide (1). A recent nationwide survey showed that approximately 15.07 million older adults aged ≥60 years had dementia between March 2015 and December 2018 in China, accounting for nearly a quarter of the world’s patients (2). Cognitive impairment is a transitional stage between being cognitively unimpaired and having dementia (2). It is estimated that 10% to 15% of mild cognitive impairment develops into Alzheimer’s disease every year (3). Since there is no cure for dementia, government and medical departments seek identification of and intervention for people with cognitive impairment to prevent the progression to dementia (2). Therefore, this study aimed to investigate the trends and subgroup differences in the prevalence of cognitive impairment among Chinese older adults aged ≥65 years over the past 20 years based on a large national sample.
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The total number of observations in this study was 73,672. The proportions of adults aged more than 80 years exceeded 60% in all waves. Women, rural residents, and those never attending school took a preponderance of this study’s sample across all waves (Table 1).
Subgroups 2002
N=15,3072005
N=13,9592008
N=14,5212011
N=8,7032014
N=6,3862018
N=14,696Women, n (%) 8,659 (56.57) 7,745 (55.48) 8,059 (55.50) 4,633 (53.23) 3,355 (52.54) 8,104 (55.14) Rural, n (%) 8,279 (54.09) 7,771 (55.67) 8,679 (59.77) 4,582 (52.65) 3,487 (54.60) 6,535 (44.47) 80–105 years, n (%) 10,492 (68.54) 9,079 (65.04) 10,296 (70.90) 5,615 (64.52) 4,099 (64.19) 9,414 (64.06) Regions, n (%) Eastern 7,371 (48.15) 6,431 (46.07) 6,696 (46.11) 4,172 (47.94) 3,093 (48.43) 7,321 (49.82) Central 3,812 (24.90) 3,520 (25.22) 3,957 (27.25) 2,430 (27.92) 1,844 (28.88) 3,696 (25.15) Western 4,124 (26.94) 4,008 (28.71) 3,868 (26.64) 2,101 (24.14) 1,449 (22.69) 3,679 (25.03) Education, n (%) Never attended school 9,365 (61.18) 8,314 (59.56) 8,820 (60.74) 4,919 (56.52) 3,535 (55.36) 6,484 (44.12) Primary school or less 4,404 (28.77) 4,120 (29.52) 4,205 (28.96) 2,769 (31.82) 2,100 (32.88) 5,567 (37.88) Secondary school or more 1,538 (10.05) 1,525 (10.92) 1,496 (10.30) 1,015 (11.66) 751 (11.76) 2,645 (18.00) Age, $ \stackrel{-}{x}\pm s $ 85.83±11.45 84.94±11.33 86.03±11.00 84.72±10.62 84.48±9.67 84.71±11.22 Abbreviation: CLHLS=Chinese Longitudinal Healthy Longevity Survey. Table 1. Characteristics of the sample from six waves of CLHLS.
The prevalence of cognitive impairment among adults aged 65–105 years decreased from 3.44% (95% CI: 3.15%–3.73%) in 2002 to 2.41% (95% CI: 2.17%–2.65%) in 2018 in China. The prevalence of cognitive impairment was slightly higher in women than in men in 2002 (3.71% vs. 3.13%, P<0.05), with the largest difference between genders in 2011 (5.82% vs. 2.47%, P<0.05), while there was no significant difference between genders in 2018 (2.60% vs. 2.21%, P=0.12). The prevalence of cognitive impairment among older adults in rural areas was higher than that in urban areas before 2014, while prevalence among rural older adults was lower than their urban counterparts in 2018 (2.06% vs. 2.75%, P<0.05). The prevalence among adults aged 80–105 years was always higher than that among those aged 65–79 years, and differences between the 2 age groups decreased from 2002 to 2018. The prevalence among older adults in the eastern region was lower than that in the western and central regions in 2002 (2.85% vs. 3.54% vs. 4.39%, P<0.05), while in 2018, the western was lower than the central and eastern regions (1.74% vs. 2.55% vs. 2.66%, P<0.05). Trends and subgroup differences in the age-standardized prevalence were similar to those in the crude prevalence (Figures 1–2).
Figure 1.Trends in the prevalence of cognitive impairment among Chinese older adults aged 65–105 years by (A) gender, (B) residence area, (C) year group, and (D) region from 2002 to 2018.
Figure 2.Trends in the age-standardized prevalence of cognitive impairment among Chinese older adults aged 65–105 years by (A) gender, (B) residence area, (C) year group, and (D) region from 2002 to 2018.
The GEE regression model showed that each successive year was associated with a 3% reduction in the odds of the prevalence of cognitive impairment [odds ratio (OR)=0.97; 95% CI: 0.97–0.97; P<0.05] after adjusting for gender, residence area, PLAD, age, and years of education. The decreasing trends in the prevalence over time were similar across subgroups (Table 2).
Subgroups OR (95% CI) P value Total * 0.97 (0.97–0.97) <0.001 Gender † Male 0.97 (0.97–0.97) <0.001 Female 0.97 (0.97–0.97) <0.001 Area § Urban 0.98 (0.98–0.98) <0.001 Rural 0.96 (0.96–0.96) <0.001 Age group ¶ 65–79 years 0.98 (0.98–0.98) 0.002 80–105 years 0.97 (0.97–0.97) <0.001 Region ** Eastern 0.98 (0.98–0.98) <0.001 Central 0.96 (0.96–0.96) <0.001 Western 0.96 (0.96–0.96) <0.001 Abbreviation: OR=odd ratio; CI=confidence interval; PLAD=provincial-level administrative divisions.
* Adjusted for gender, area, age, PLAD, and years of education.
† Adjusted for area, age, PLAD, and years of education.
§ Adjusted for gender, age, PLAD, and years of education.
¶ Adjusted for gender, area, PLAD, and years of education.
** Adjusted for gender, area, age, and years of education.Table 2. OR and 95% CI of cognitive impairment related to year in different subgroups from generalized estimating equation models.
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