Importance Previous estimates suggested that 1 in 3 cases of Alzheimer disease and related dementia (ADRDs) in the US are associated with modifiable risk factors, the most prominent being physical inactivity, depression, and smoking. However, these estimates do not account for changes in risk factor prevalence over the past decade and do not consider potential differences by sex or race and ethnicity. Objective To update estimates of the proportion of ADRDs in the US that are associated with modifiable risk factors and to assess for differences by sex and race and ethnicity. Design, Setting, and Participants For this cross-sectional study, risk factor prevalence and communality were obtained from the nationally representative US Behavioral Risk Factor Surveillance Survey data from January 2018 to December 2018, and relative risks for each risk factor were extracted from meta-analyses. Data were analyzed from December 2020 to August 2021. Respondents included 378 615 noninstitutionalized adults older than 18 years. The number before exclusion was 402 410. Approximately 23 795 (~6%) had missing values on at least 1 of the variables of interest. Exposures Physical inactivity, current smoking, depression, low education, diabetes, midlife obesity, midlife hypertension, and hearing loss. Main Outcomes and Measures Individual and combined population-attributable risks (PARs) associated with ADRDs, accounting for nonindependence between risk factors. Results Among 378 615 individuals, 171 161 (weighted 48.7%) were male, and 134 693 (weighted 21.1%) were 65 years and older. Race and ethnicity data were self-reported and defined by the US Behavioral Risk Factor Surveillance System Data; 6671 participants (weighted 0.9%) were American Indian and Alaska Native, 8043 (weighted 5.1%) were Asian, 29 956 (weighted 11.7%) were Black, 28 042 (weighted 16.0%) were Hispanic (any race), and 294 394 (weighted 64.3%) were White. Approximately 1 in 3 of ADRD cases (36.9%) in the US were associated with 8 modifiable risk factors, the most prominent of which were midlife obesity (17.7%; 95% CI, 17.5-18.0), physical inactivity (11.8%; 95% CI, 11.7-11.9), and low educational attainment (11.7%; 95% CI, 11.5-12.0). Combined PARs were higher in men (35.9%) than women (30.1%) and differed by race and ethnicity: American Indian and Alaska Native individuals, 39%; Asian individuals, 16%; Black individuals, 40%; Hispanic individuals (any race), 34%; and White individuals, 29%. The most prominent modifiable risk factors regardless of sex were midlife obesity for American Indian and Alaska Native individuals, Black individuals, and White individuals; low education for Hispanic individuals; and physical inactivity for Asian individuals. Conclusions and Relevance The findings suggest that risk factors associated with ADRDs have changed over the past decade and differ based on sex and race and ethnicity. Alzheimer risk reduction strategies may be more effective if they target higher-risk groups and consider current risk factor profiles.

中文翻译：

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在美国按性别、种族和民族划分的与阿尔茨海默病和相关痴呆症相关的风险因素。

重要性 先前的估计表明，在美国，三分之一的阿尔茨海默病和相关痴呆 (ADRD) 病例与可改变的风险因素有关，最突出的是缺乏运动、抑郁和吸烟。然而，这些估计没有考虑过去十年中危险因素流行率的变化，也没有考虑性别或种族和民族的潜在差异。目的 更新美国 ADRD 中与可改变的危险因素相关的比例估计值，并评估性别、种族和民族的差异。设计、设置和参与者对于这项横断面研究，风险因素的普遍性和共同性是从 2018 年 1 月至 2018 年 12 月具有全国代表性的美国行为风险因素监测调查数据中获得的，每个风险因素的相对风险是从荟萃分析中提取的。分析了 2020 年 12 月至 2021 年 8 月的数据。受访者包括 378 615 名 18 岁以上的非机构化成年人。排除前的人数为 402 410。大约 23 795 (~6%) 至少有 1 个感兴趣的变量缺失值。暴露 缺乏运动、目前吸烟、抑郁、低学历、糖尿病、中年肥胖、中年高血压和听力损失。主要结果和措施 与 ADRD 相关的个体和组合人群归因风险 (PAR)，说明风险因素之间的非独立性。结果 在 378 615 人中，171 161 人（权重 48.7%）为男性，134 693 人（权重 21.1%）为 65 岁及以上。种族和民族数据由美国行为风险因素监测系统数据自行报告和定义；6671 名参与者（权重 0.9%）是美洲印第安人和阿拉斯加原住民，8043 名参与者（权重 5.1%）是亚裔，29956 名参与者（权重 11.7%）是黑人，28042 名参与者（权重 16.0%）是西班牙裔（任何种族），294394 名参与者（加权 64.3%）是白人。在美国，大约三分之一的 ADRD 病例 (36.9%) 与 8 个可改变的风险因素相关，其中最突出的是中年肥胖 (17.7%; 95% CI, 17.5-18.0)、缺乏运动 (11.8%; 95 % CI，11.7-11.9）和低教育程度（11.7%；95% CI，11.5-12.0）。男性 (35.9%) 的综合 PAR 高于女性 (30.1%)，并且因种族和种族而异：美洲印第安人和阿拉斯加原住民个体，39%；亚洲人，16%；黑人个体，40%；西班牙裔（任何种族），34%；和白人，29%。无论性别如何，最突出的可改变风险因素是美洲印第安人和阿拉斯加原住民、黑人和白人的中年肥胖；西班牙裔人受教育程度低；和亚洲人缺乏身体活动。结论和相关性 研究结果表明，与 ADRD 相关的危险因素在过去十年中发生了变化，并且因性别、种族和民族而异。如果针对高危人群并考虑当前的风险因素概况，则降低阿尔茨海默病风险的策略可能会更有效。西班牙裔个人受教育程度低；和亚洲人缺乏身体活动。结论和相关性 研究结果表明，与 ADRD 相关的危险因素在过去十年中发生了变化，并且因性别、种族和民族而异。如果针对高危人群并考虑当前的风险因素概况，则降低阿尔茨海默病风险的策略可能会更有效。西班牙裔个人受教育程度低；和亚洲人缺乏身体活动。结论和相关性 研究结果表明，与 ADRD 相关的危险因素在过去十年中发生了变化，并且因性别、种族和民族而异。如果针对高危人群并考虑当前的风险因素概况，则降低阿尔茨海默病风险的策略可能会更有效。