| Alzheimer’s disease(AD) is a progressive fatal neurodegenerative disease with clinicalmanifestations of deteriorating cognitive and memory functions, progressive decliningdaily living activities, and a variety of neuropsychiatric symptoms and behavioral disorders.AD severely threatens human being’s health for its constant high incidence rate, mortalityrate and handicap-causing rate. Enormous studies showed that the prognosis was improvedlittle no matter how perfect the treatment had been for the AD patients. As AD was animportant factor of death and handicap for the aged, the burden of disease of AD wouldbecome greater for human beings with the acceleration of aging tendency in both Chinaand the world. Therefore, it has great practical significance to understand the burden of ADcomprehensively. In this study, a more comprehensive study on the burden of disease inAD was conducted based on the status and prediction of disease burden to provide basis fordevelopment for AD burden research and a rational allocation of future health resources.The burden of disease for AD was investigated at four levels, namely patient burden,economic burden, the burden of caregivers and family burden. The burden of patientgroups used the country coroner’s monitoring system data. By cluster sampling in Taiyuancity, 168 patients with Alzheimer’s disease were selected from 2 upper first-class hospitalsand 3 large communities. In addition, there were 168 family members of patientsparticipated in the survey of caregivers burden and family burden.AD patient burden was evaluated by disability-adjusted life year (DALY). First YLLwas calculated by mortality data, then the burden of disease model was fitted to calculateYLD. The results showed that AD patient burden was greater than the domestic researchresults. For people aged over 60 years, per thousand DALYs was 6.46, 8.65 and 7.59 formales, females and the total, respectively. For YLL, per thousand YLLs and mortality formen were higher than women and increased with age. For YLD, per thousand YLDs andmortality for women were higher than men and increased with age.The economic burden of AD was evaluated by direct medical costs, directnon-medical costs and indirect costs.The direct medical costs include registration fees,clinic fees, laboratory fees, inspection fees, medical fees, medicines, etc; Directnon-medical expenses include transportation, lodging, food, nutrition, health care costs,caregivers employment costs, commercial health insurance costs, etc; Indirect costs meanthe loss of unpaid care due to illness or physical discomfort. The results showed that the direct medical costs, direct non-medical costs, indirect costs of AD and the total were 7708,6516, 1525 and 15749 RMB, respectively. Multivariate analysis showed that gender, ageand cognitive function were the main factors for total cost of economic burden of ADpatients.Burden on caregivers was assessed by caregivers burden questionnaire (CBI) and pathanalysis was used to build the factors on the final burden. The results showed thatcaregivers burden score was 47.54±17.61 at a medium level. The lower level of cognitivefunction in patients and the longer time taken care of patient, the more burden of caregivers.Some adjustment factors have direct impacts on the burden of caregivers.The higher socialsupport, family care and positive feeling, the less burden of caregivers. The care time,social support and family care were directly related with the patient’s cognitive level, butwere intermediate adjustments of the level of cognitive function in patients with the burdenof caregivers. Similarly, the social support was the middle adjustment variable betweenpatients’ daily capacity and the burden of caregivers; while care time and positive feelingswere the middle adjustment variables between the behavioral and psychological symptomsin patients and the burden of caregivers.At the family level, the Family Burden Scale (FBS) was applied to estimate familyburdens of the patients’ families. Firstly, the reliability, validity and responsiveness of FBSwere verified. Secondly, the scores of all dimensions were calculated and analyzed. Thirdly,the impact factors on the total score of FBS were determined using a multiple stepwiseregression analysis.The results showed that the split-half reliability (0.930) and the internalconsistency of FBS (Cronbach’s alpha coefficients of the 6 dimensions ranged from 0.691to 0.734) were high. The content validity, construct validity and responsiveness of FBSwere all acceptable. Various dimensions of family burden of AD patients with varyingdegrees of burden, the burden of family life and family entertainment compared to theother dimension are even more significant.The impact factors of the total score of FBSincluded patients’ gender, cognitive function and daily living skills.Finally, we used a multi-state time-discrete Markov model to predict the number ofAD prevalence during 2010-2030. The transition included health state (S0) progression toearly disease stage (S1), and then to the advanced disease stage (S2). The individuals had acertain risk of death at every stage. The results showed that about 6,621,268 people willsuffer from AD in 2010, 2,920,486 male patients (44.1%), 3,700,782 (55.9%) femalepatients; the early stage of the disease 3,730,547 (56.3%), late stage of 2,890,721 (43.7%),and prevalence will increase with age. The number of AD prevalence in 2030 may increase by 2.42 times due to demographic factors, about 44.2:55.8 of male to female patients, theproportion of early to late stable (55.9:44.1). Under the program P (in 2012 theimplementation of preventive interventions has led to delay disease onset by 2 years) theprevalence of AD will increase only 1.85 times in 2030, the ratio of male to female patientsabout 44.2:55.8, the proportion of early to late stable (56.0:44.0). For program T (in 2012the implementation of therapeutic interventions led to disease progression delayed 2 years),the prevalence will increase 2.54 times, slightly higher than program D (basic program);male to female patients with a ratio of about 44.2:55.8; early to late ratio of 64.1:35.9.Program C means a good representation of these two interventions, with the overallprevalence increased by 1.94 times, proportion of early to late changed (64.2:35.8), whileratio of male to female patients unchanged about 44.2:55.8.In summary:(1) Mean disability adjusted life years for the older in the monitoring area was7.59/1000 people. Burden of AD patients was serious with decreased quality of life.(2) Economic burden of AD patients was heavier, similar to other related researchresults. Medical costs, direct non-medical costs and indirect costs accounted for 48.9%,9.7% and 41.4%, respectively. Health care costs due to AD and loss of time for the patientsand caregivers due to care for patients were higher.(3) Cognitive level, daily behavior, behavioral and psychiatric symptom severity ofAD patients were related to caregiver’s burden. Social support, family care and self positivefeelings were also related to caregiver’s burden. Concerning the patient’s problems andactively promoting caregiver’s humanistic care will be helpful for reducing the caregiver’sburden.(4) Family burden in patients with AD was heavier compared to other studies. Dailylife and entertainment aspects of family members of AD patients were greatly influenced.(5) The results showed that there will be 16,032,655 people with AD in 2030 in China.Prevention and control measures will effectively reduce the AD prevalence and the burdenof family and society. |
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