Alzheimers Dement. 2014 Mar;10(2):e47-92. doi: 10.1016/j.jalz.2014.02.001.
This report discusses the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality rates, costs of care, and overall effect on caregivers and society. It also examines the impact of AD on women compared with men. An estimated 5.2 million Americans have AD. Approximately 200,000 people younger than 65 years with AD comprise the younger onset AD population; 5 million are age 65 years or older. By mid-century, fueled in large part by the baby boom generation, the number of people living with AD in the United States is projected to grow by about 9 million. Today, someone in the country develops AD every 67 seconds. By 2050, one new case of AD is expected to develop every 33 seconds, or nearly a million new cases per year, and the total estimated prevalence is expected to be 13.8 million. In 2010, official death certificates recorded 83,494 deaths from AD, making AD the sixth leading cause of death in the United States and the fifth leading cause of death in Americans aged 65 years or older. Between 2000 and 2010, the proportion of deaths resulting from heart disease, stroke, and prostate cancer decreased 16%, 23%, and 8%, respectively, whereas the proportion resulting from AD increased 68%. The actual number of deaths to which AD contributes (or deaths with AD) is likely much larger than the number of deaths from AD recorded on death certificates. In 2014, an estimated 700,000 older Americans will die with AD, and many of them will die from complications caused by AD. In 2013, more than 15 million family members and other unpaid caregivers provided an estimated 17.7 billion hours of care to people with AD and other dementias, a contribution valued at more than $220 billion. Average per-person Medicare payments for services to beneficiaries aged 65 years and older with AD and other dementias are more than two and a half times as great as payments for all beneficiaries without these conditions, and Medicaid payments are 19 times as great. Total payments in 2014 for health care, long-term care, and hospice services for people aged 65 years and older with dementia are expected to be $214 billion. AD takes a stronger toll on women than men. More women than men develop the disease, and women are more likely than men to be informal caregivers for someone with AD or another dementia. As caregiving responsibilities become more time consuming and burdensome or extend for prolonged durations, women assume an even greater share of the caregiving burden. For every man who spends 21 to more than 60 hours per week as a caregiver, there are 2.1 women. For every man who lives with the care recipient and provides around-the-clock care, there are 2.5 women. In addition, for every man who has provided caregiving assistance for more than 5 years, there are 2.3 women.
本报告讨论了阿尔茨海默病(AD)对公共卫生的影响,包括发病率和患病率、死亡率、护理成本,以及对护理人员和社会的总体影响。它还研究了 AD 对女性与男性的影响差异。据估计,有 520 万美国人患有 AD。大约有 20 万年龄在 65 岁以下的 AD 患者属于早发性 AD 人群;500 万人年龄在 65 岁或以上。到本世纪中叶,在很大程度上受到婴儿潮一代的推动,美国患 AD 的人数预计将增加约 900 万。如今,美国每 67 秒就有一人患上 AD。到 2050 年,预计每 33 秒就会出现一例新的 AD 病例,即每年新增近 100 万例,总预计患病率将达到 1380 万。2010 年,官方死亡证明记录了 83494 例 AD 死亡,使 AD 成为美国第六大死因,也是 65 岁及以上美国人的第五大死因。2000 年至 2010 年间,心脏病、中风和前列腺癌导致的死亡比例分别下降了 16%、23%和 8%,而 AD 导致的死亡比例上升了 68%。AD 实际导致的死亡人数(或 AD 相关死亡人数)可能远高于死亡证明上记录的 AD 死亡人数。2014 年,预计有 70 万美国老年人将死于 AD,其中许多人将死于 AD 引起的并发症。2013 年,超过 1500 万家庭成员和其他无薪护理人员为 AD 患者和其他痴呆症患者提供了约 177 亿小时的护理,其价值超过 2200 亿美元。医疗保险向 65 岁及以上患有 AD 和其他痴呆症的受益人的服务支付的人均费用是所有没有这些疾病的受益人的两倍半以上,医疗补助支付的费用是 19 倍。2014 年,为 65 岁及以上痴呆症患者提供的医疗、长期护理和临终关怀服务的总费用预计为 2140 亿美元。AD 对女性的影响比对男性更大。女性患这种疾病的人数多于男性,而且女性比男性更有可能成为 AD 或其他痴呆症患者的非正式护理人员。随着护理责任变得更加耗时和繁重,或者持续时间延长,女性承担的护理负担会更大。每有一名男性每周花 21 到 60 多小时做护理人员,就有 2.1 名女性。每有一名男性与护理接受者住在一起并提供 24 小时护理,就有 2.5 名女性。此外,每有一名男性提供了超过 5 年的护理协助,就有 2.3 名女性。