A cohort study on mortality and risk of death among population diagnosis as dementia, at base-line survey, in Beijing / 中华流行病学杂志

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.

Metabolic syndrome is an independent risk factor for cardiovascular disease events in patients with ischemic stroke / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the association between metabolic syndrome (MS) and risk of cardiovascular disease events (CVD) in patients with ischemic stroke.</p><p><b>METHOD</b>A total of 1087 patients with ischemic stroke were enrolled from 5 community-based medical centres and underwent baseline evaluation on risk factors of stroke during the period of Jan. 2003 to Dec. 2006. After baseline survey, all patients were followed up until Dec 31, 2008 and new CVD events were recorded. MS was defined using CDS criteria. Proportional hazard models were used to assess the HRs and 95% CI of CVD events associated with MS and other components.</p><p><b>RESULTS</b>The prevalence of MS was 40.4% at baseline. During an average follow-up of 3.5 years, 178 patients developed new CVD events. After adjusted for age, gender, smoking, drinking, marriage status, education level, hospitalization, recurrence of stroke, stroke duration, depression, cognition impairment and ADL, MS remains the independent predictor for the risk of CVD events. Compared with patients with non-MS, the risk of CVD events increased by 44% (HR: 1.44, 95%CI: 1.06 - 1.95). The risk of CVD also increased with the number of MS components. Compared with patients with 1 or less than 1 components of MS, the risk of CVD events increased by 30% (HR: 1.30, 95% CI: 0.83 - 2.04) in those with 2 components and by 69% (HR: 1.69, 95%CI: 1.11 - 2.56) in those with 3 or more components of MS. Hypertension and hyperglycemia and impaired fasting glucose also served as independent risk factors for CVD event (all P < 0.001).</p><p><b>CONCLUSIONS</b>MS was independently associated with increased risk of CVD events in patients with ischemic stroke. There was a dose-response relationship between the numbers of MS components and the risk of CVD event.</p>

Prospective study on associations between levels of total cholesterol, triglyceride and risk of ischemic and hemorrhagic strokes / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore associations between levels of total cholesterol (TC), triglyceride (TG) and incidence of ischemic and hemorrhagic strokes in populations.</p><p><b>METHODS</b>Baseline investigations on stroke-related risk factors and physical examinations were performed in 10 093 (> 35 years) stroke-free urban community residents from 5 cities in China during May to July in 1987, follow-up investigations on stroke events were made during 1998 to 2000. The hazard ratios and 95% confidence intervals (CI) of ischemic and hemorrhagic strokes in middle, high tertiles of baseline TC or TG levels were compared with low baseline tertile residents using the Cox regression model.</p><p><b>RESULTS</b>There were 491 first strokes during the 8-years cohort follow-up. Compared with the low tertile, risk of ischemic stroke in the middle and high tertiles of TC level was increased by 61% (HR: 1.61, 95%CI: 1.14-2.27) and 58% (HR: 1.58, 95%CI: 1.12-2.22) after adjustments for DBP, age, sex and other variables in the Cox proportional hazards model. Compared with the low tertile, risk of ischemic stroke in the high tertile of TG level was increased by 43% (HR: 1.43, 95%CI: 1.02-2.00). However, risk of hemorrhagic stroke in the middle and high tertiles of TC level decreased by 12% (HR: 0.88, 95%CI: 0.64-1.22) and 33% (HR: 0.67, 95%CI: 0.48-0.95) compared with the low tertile.</p><p><b>CONCLUSIONS</b>Elevated serum TC and TG are independent risk factors for risk of ischemic stroke. However, low TC was related with increased risk of hemorrhagic stroke.</p>

Study on the incidence and risk factors of dementia in elderly residents from communities in Beijing / 中华流行病学杂志

Objective To study the incidence of dementia and its risk factors among the elderly living in the community of Beijing. Methods A sample of 2788 elderly residents from Beijing were investigated regarding the incidence of dementia which was diagnosed using two-stage method in 1997. In the first stage, questionnaire was filled, including MMSE checked up. In the second stage, all the elderly who had lower 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 on 2000 and 2004 by the same way, with the overall time for following-up as 7.25 years. Results 171dementias cases were diagnosed among the 2788 elderly in 1997. At the end of the survey, another 180 new cases developed. The average weighted incidence was 0.84/100 person year, adjusted by age (it's same followed), with 0.64/100 person year in males and 1.01/100 person years in females. The incidence of vascular dementia was 0.35/100 person years, with male as 0.39/100 person year and female as 0.32/100 person years. The incidence of dementia was increasing with age, but decreasing with time of education by Multinomial Logistic Regression Analysis. Old age and illiterate appeared to be the risk factors for dementia. People with stroke history and elevated systolic blood pressure were risk factors for vascular dementia. Conclusion The incidence of dementia in the elderly in Beijing was higher than in other areas of China. Old age and illiterate were risk factors for dementia. Being male, illiterate, with stroke history and elevated systolic blood pressure were risk factors for vascular dementia.

Effects and trends of stroke and life expectancy among older adults-from 1990s to 2000s / 中华流行病学杂志

Objective To explore the experience of stroke influencing the lire expectancy(LE),active life expectancy(ALE),inactive life expectancy(IALE),and the trend of 1ife expectancy among older adults,from 1990s to 2000s in Beijing,China.Methods A representative sample of 3257 elderly people living in urban or rural communities in Beijing were followed up from 1990 until 2004.Their health and survival status had been surveyed every 3-5 years.Activity Daily Living(ADL)scale,recommended bv WHO was used to evaluate the physical function capability of the elderly.SAS was used to estimate LE,ALE and IALE for both periods of 1992-1997 and 2000-2004 by age and by areas of residency(rural or urban).Results LE and ALE were shorter.and IALE was longer,among the elderly with stroke than those without stroke at all age groups.Functional Status at baseline was also a very important factor in determining ALE and IALE.For those active at baseline,ALE in the elderly with stroke was shorter than those without.There were no difiererlces found in IALE between those with or without stroke.but ALE was longer than LALE.For the elderly with stroke and inactive at baseline.their IALE were longer than ALE and their ALE were at low levels in all age groups.Among those with stroke and living in urban,their LE and ALE were longer than those living in the rural area.When comparing with the period of 1992-1997.botll LE and ALE increased during the period of 2000-2004 in all the elderly groups,both in urban and rural areas.The largest increment occurred among those with stroke who originated in an inactive state.Conclusion Stroke reduced both quality and quantity of life of the elderly.The reductions of LE and ALE were greater among the elderly with stroke in rural than in urban areas.Both LE and ALE increased from 1992-1997 to 2000-2004 among the elderly with stroke in both urban and rural areas.

Effect of Hypertension on Life Quality in Elderly / 中华高血压杂志

Objective To explore the effect of hypertension on the life quality in elderly.Methods A cohort of 1847 elderly in community in Beijing was recruited.Blood pressur,body structural and mental heath,cognition, activity and life satisfaction were evaluated by physical examination,CES-D scale,MMSE,and ADL,IADL scale.Results The life quality of the elderly hypertension was worse than those of normotensive;the morbidi- ties of chronic disease related to hypertension were higher and the cognitive ability worse with the duration of hy- pertension.The prevalence of depression was higher and the vitality was decreased as the rising of blood pres- sure.Conclusion Prevention and control hypertension improve life quality in elderly hypertension.

Study on the isolated systolic hypertension and its prognosis among 2866 elderly residents at the community level in Beijing / 中华流行病学杂志

<p><b>OBJECTIVE</b>We followed a group of community residents above 60 years old to investigate how isolated systolic hypertension (ISH) could influence the prognosis in the long run among the elderly.</p><p><b>METHODS</b>A selected sample of 60 year olds and over from the Beijing residential communities was randomized ascertained to a longitudinal study. Baseline data was collected in 1993 and 11 years later in 2004, the all-cause death, mortality of cardiovascular and cerebrovascular diseases were observed and analyzed.</p><p><b>RESULTS</b>(1) The morbidity of hypertension(HT) was 61.7% and ISH was 27.8% seen in baseline survey while the SBP was increasing with age. (2) The longitudinal study showed that the total mortality and the mortality of cardiovascular and cerebrovascular diseases in HT group were higher than in the normal blood pressure(BP) group. The total mortality in the group ISH was higher than in normal BP group (55.2%: 46.2%; P < 0.01). The mortality OR for group ISH/group normal BP was 1.4 and group DSH/group normal BP was 1.6. The level of SBP was related to prognosis too which showed that the mortality appeared the lowest in 120-139 mm Hg group, and increased when the level of SBP was above 140 mm Hg.</p><p><b>CONCLUSION</b>SBP was an independent risk factor on the all-cause mortality and the mortality of cerebrovascular diseases in eldevly. ISH also appeared a risk factor on the prognosis among the elderly, suggesting that more attention should be paid to it and treatment be carefully addressed.</p>

Evaluation on a community-based intervention program among people with different risk factors of stroke / 中华流行病学杂志

<p><b>OBJECTIVE</b>To evaluate the effect of a long-term community-based intervention program on risk factors of stroke among people with different risk factors.</p><p><b>METHODS</b>In 1987,2 geographically separated communities with 10 000 registered residents of each, were selected as either intervention or control communities in Beijing and Changsha. A cohort containing 2700 subjects at the age of 35 years or older,and free of stroke were sampled from each community. The baseline survey was conducted to screen the subjects at high risk for intervention and there were 5319 and 5506 subjects enrolled in intervention and control cohorts,respectively. Then,a program for controlling the risk factors of stroke was initiated in the intervention cohort and health education was provided to the whole intervention community. A follow-up survey was conducted in 1999. The information on incidence and mortality of stroke was collected.</p><p><b>RESULTS</b>Comparing with the control cohort, the risk of incidence and mortality of stroke decreased by 22 % ( HR = 0.78,95 % CI:0. 66-0.92) and 73 % (HR = 0.27,95 % CI:0. 17-0.42) in intervention cohort. The risks of stroke were lower in intervention cohort than in control cohort among almost all of the sub-groups with or without risk factors of stroke except for being male,current smokers and current alcohol drinkers. The risk of death caused by stroke decreased significantly in those with or without the risk factors of stroke.</p><p><b>CONCLUSION</b>The long-term community intervention on the risk factors of stroke could effectively reduce the risk of incidence and mortality of stroke among people with or without the risk factors of stroke. More attention should be paid to the males and those who smoke or drink alcohol.</p>

Study on Depression of Hypertension and Associated Factors in Elderly Population in the Community of Beijing / 中华高血压杂志

Objective To explore the depression status of hypertension and analyze the associated factors in the elderly population in a community of Beijing.Methods This cohort of 1064 elderly people in the community were screened with Centerfor Epidemiology Scale(CES-D). Results Those who lived in rural(21.6% vs city 7.3%),illiterate(19.9% vs literate 11.2%),mateless(19.7% vs mate 12.4%),lower income(21.9% vs high in- come 9.8%),life accidents(23.2% vs without life accidents 8.6%),sleep disorder(31.0% vs sleep good 8.7%) and lower living abilities(26.7% vs high living ability 9.0%)had higher incidence of depression(all P

A comprehansive evaluation on stroke prevalence among elderly in urban and rural areas of Beijing, 2002 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To describe the prevalence and disability of stroke as well as the stroke-related diseases among elderly in urban and rural regions of Beijing.</p><p><b>METHODS</b>In 2002, three communities were selected from urban, suburb and rural regions from Beijing areas, respectively. Twenty percent of the elderly were randomly selected from three communities. The information about history of stroke, hypertension, heart diseases and diabetes, self-rated health (SRH), activity of daily living (ADL) and instrumental ADL (IADL), smoking and drinking habits, knowledge about cardiovascular diseases prevention were collected.</p><p><b>RESULTS</b>A total of 2487 elderly were interviewed and the prevalence of stroke was 12.9% (321/2481). Eighty-seven of the stroke patients were diagnosed by CT/MRI. 19.9% of stroke patients had experienced 2 or more attacks. The highest prevalence of stroke was in the urban region and the lowest in the rural region (16.9% vs. 8.5%, P for trend < 0.01) while it was higher in males than in females (P < 0.05). The prevalence of stroke tended to increase with age in urban and 34.6% of the stroke patients had recovered completely. The proportions of poor SRH, ADL and IADL dependence, as well as the prevalences of hypertension, heart diseases and diabetes were higher among the elderly with stroke than those without. Although rates of awareness and treatment of hypertension were at the high levels among the elderly with stroke , the control rate was low, especially in the rural region (as low as 4.3%). The level of knowledge on the prevention of cardiovascular diseases, and the rates of smoking and drinking were similar between the elderly with or without stroke.</p><p><b>CONCLUSION</b>The prevalence of stroke had increased dramatically during the past decade in Beijing. The proportion of poor SHR, ADL and IADL dependence, prevalence rates of stroke related diseases were higher among the elderly with stroke than those without. Secondary prevention of stroke among Beijing elderly called for urgent action.</p>

Study on the active life expectancy of the elderly and its longitudinal transition in Beijing / 中华流行病学杂志

<p><b>OBJECTIVE</b>Focus on the Active Life Expectancy (ALE) of elderly in Beijing and the transition in recent years.</p><p><b>METHODS</b>A representative sample of 3257 elderly people who lived in the urban, suburban and rural communities in Beijing that had been followed up for 12 years. Their health and survival status had been surveyed every 2-3 years. Activity Daily Living scale (ADL), recommended by WHO was used to evaluate the physical function capability of the elderly. IMaCH 0.8 was used to estimate life expectancy (LE) and active life expectancy (ALE) for both periods while age, sex and rural/urban residence areas were adjusted.</p><p><b>RESULTS</b>Longitudinally, data showed that the main characters remained unchange throughout the two periods including 1) LE, ALE, ALE/LE of elderly living in urban area were higher than those living in rural area; 2) LE seemed longer in women than men, but ALE/LE was less in women. The transition between two period showed that 1) LE increased modestly in all groups but less prominent in urban residents and in females; 2) ALE was not significantly changed in the rural elderly but declined markedly in women living in the urban area; 3) ALE/LE of the elderly declined in all groups, especially in urban and oldest old groups.</p><p><b>CONCLUSION</b>In Beijing, elderly AL-E did not increase in parallel with the increase of LE while ALE/LE of the elderly declined significantly in recent years. In order to improve quality of life of the elderly and to increase their ALE, emphasis should be given to prevention of cardiovascular, cerebrovascular and other chronic diseases while reducing the occurrence of physical disability and strengthening on rehabilitation would be the basic health care measures.</p>

Evaluation of predictive effect of some health-related indices on deaths among ageing residents through a 8-years' follow-up study in Beijing / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the predictive effects of some health status indicators to deaths in the elderly population.</p><p><b>METHODS</b>In 1992, a cohort of 3257 people older than 55 years old was formed from Beijing urban and suburb area. Demographic and information of activity of daily living (ADL), self-rated health (SRH), chronic diseases history and other related variables were collected at baseline survey in 1992. MMSE and CES-D were studied in 2101 on 3257 elderly people. Follow-up surveys were conducted in 1994, 1997 and 2000, to find that a total number of or= 75), resident place (suburb) and education level (illiteracy). The functional disability, poor self-rated health status, history of chronic diseases and abnormal cognition function were the major predictors of deaths. Multinomial logistic regression analysis showed that after adjustment for sex, age, residential place, education level and history of chronic diseases, functional disability, poor self-rated health status and abnormal cognition function remained as significant independent predictors to death.</p><p><b>CONCLUSIONS</b>Functional disability, poor self-rated health status and abnormal cognition function were the most valuable indicators of death. Not only they had joined predictive effects to death, but also remained relatively independent. They had important value in the evaluation on healthy prognosis and the life quality of the elderly.</p>

Study on the relationship between self-rated health situation and health status in the elderly-an 8-year follow-up study from Multidimentional Longitudinal Study of Aging in Beijing / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the relationship between self-rated health (SRH) and prevalence of chronic diseases, and all-cause mortality in the elderly population.</p><p><b>METHODS</b>In 1992, a cohort of 3257 people > or = 55 years old was selected from Beijing, the information of SRH and other related variables were collected from 3 157 subjects at the baseline survey. Three follow-up surveys were conducted in 1994, 1997 and 2000, respectively.</p><p><b>RESULTS</b>The SRH was influenced by age, gender, marriage status and satisfaction on their own economic condition. Comparing the subjects with excellent SRH, the prevalence rates of chronic diseases, stroke, heart diseases and respiratory system diseases were almost doubled among those with average and poor SRH. By 2000, 993 death occurred. All-cause mortality was negatively associated with SRH, i.e. the risk of death was 12% which was 53% higher for the subjects with average SRH (HR = 1.12, 95% CI: 0.93 - 1.35) and poor SRH (HR = 1.53, 95% CI: 1.25 - 1.88) than those with excellent SRH, respectively. The risks of death from stroke and heart disease were 2.25 (HR = 2.25, 95% CI: 1.67 - 3.04) and 2.22 (HR = 2.22, 95% CI: 1.61 - 3.07) times higher among the subjects with poor SRH than those with excellent SRH respectively. After adjustment for age, gender, resident place, marriage status, education, satisfaction on their own economic condition, seeing doctors or hospitalized within the last 1 year, history of chronic disease, cognition function, body mass index, activities of daily living and depression, as well as deleted the subjects died within first or third year of the baseline survey respectively, poor SRH remained a significantly independent predictor to all-cause death as well as to the death of stroke and heart diseases.</p><p><b>CONCLUSIONS</b>The frequency of poor SRH was influenced by age, gender, marriage status and satisfaction on their own economic condition. Poor SRH was associated with the prevalence of chronic conditions and mortality among the elderly. The findings suggested that SRH might have served as an important indicator in the evaluation on health status among the elderly.</p>

Community intervention on hypertension and stroke / 中华流行病学杂志

<p><b>OBJECTIVE</b>To evaluate the community-based intervention on reduction of hypertension and stroke in different age groups and subtypes hypertension.</p><p><b>METHODS</b>In 6 cities, 2 geographically separated communities with a registered population about 10 000 of each were selected as either intervention or control communities. A cohort containing 2 700 subjects, 35 years or older, and free of stroke were sampled from each community. The baseline survey was conducted to screen the subjects for intervention. In each city, a program for control of hypertension, heart diseases and diabetes was initiated in the intervention cohort and health education was provided to the whole intervention community. A follow-up survey was conducted 3 years later.</p><p><b>RESULTS</b>Within 3 years, the prevalence of hypertension increased in both intervention and control cohorts, as well as in the middle and elderly cohorts, especially in the middle aged in control group. Among hypertensives in the intervention cohort, the rates of awareness, treatment and control of hypertension got improved. The incidence of stroke was 29% lower (HR = 0.71, 95% CI: 0.58 - 0.87) and mortality of stroke was 40% lower (HR = 0.60, 95% CI: 0.42 - 0.86) in the intervention cohort than the control cohort. The intervention was most effective in reduction of stroke for those with isolated systolic hypertension and combined systolic and diastolic hypertension (All P < 0.05). Meanwhile, all-cause mortality was 11% lower (HR = 0.89, 95% CI: 0.78 - 0.99) in the intervention cohort than in the control cohort.</p><p><b>CONCLUSION</b>The community-based intervention was effective in controlling the development of hypertension and stroke, while the elderly people benefit more than the middle aged people from the intervention.</p>