Longitudinal Study of the Association between General Anesthesia and Increased Risk of Developing Dementia
Abstract
:1. Introduction
2. Materials and Methods
2.1. Korea National Health Insurance Service
2.2. Study Population
2.3. Predictor and Outcome Variables
2.4. Sensitivity Test
2.5. Statistical Analysis
3. Results
3.1. Effect of General Anesthesia on the Incidence of Dementia in Patients Older Than 55 Years
3.2. Hazard Ratios for Dementia in Patients Aged over 55 Years Who Underwent General Anesthesia
3.3. Sensitivity Test for Effect of General Anesthesia on the Incidence of Dementia
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
Appendix A
The Number of Dementia Events | |
---|---|
Event | 1015 |
Non-anesthesia | 775 |
General anesthesia | 240 |
Total censored (No event) | 14,485 |
Non-anesthesia | 11,625 |
General anesthesia | 2860 |
Termination of study | 8587 |
Non-anesthesia | 6446 |
General anesthesia | 2141 |
Loss to follow up/Drop-out | 5898 |
Non-anesthesia | 5179 |
General anesthesia | 719 |
Variables | Comparison (n = 18,706) | Dementia (n = 9353) | p Value |
---|---|---|---|
Sex | 0.929 | ||
Male | 5239 (28.0%) | 2614 (27.9%) | |
Female | 13,467 (72.0%) | 6739 (72.1%) | |
Ages (years) | 1.000 | ||
65–74 | 4260 (22.8%) | 2130 (22.8%) | |
75–84 | 9310 (49.8%) | 4655 (49.8%) | |
≥85 | 5136 (27.5%) | 2568 (27.5%) | |
Residence | 0.588 | ||
Seoul | 2562 (13.7%) | 1281 (13.7%) | |
Second area | 4506 (24.1%) | 2304 (24.6%) | |
Third area | 11,638 (62.2%) | 5768 (61.7%) | |
Household income | 0.990 | ||
Low (0–30%) | 6267 (33.5%) | 3140 (33.6%) | |
Middle (30–70%) | 4140 (22.1%) | 2064 (22.1%) | |
High (70–100%) | 8299 (44.4%) | 4149 (44.4%) | |
Comorbidities | 0.688 | ||
No | 2697 (14.4%) | 1366 (14.6%) | |
Yes | 16,009 (85.6%) | 7987 (85.4%) |
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Variables | Comparison (n = 12,400) | General Anesthesia (n = 3100) | p Value |
---|---|---|---|
Sex | 1.000 | ||
Male | 5744 (46.3%) | 1436 (46.3%) | |
Female | 6656 (53.7%) | 1664 (53.7%) | |
Ages (years) | 1.000 | ||
55–64 | 6532 (52.7%) | 1633 (52.7%) | |
65–74 | 4432 (35.7%) | 1108 (35.7%) | |
≥75 | 1436 (11.6%) | 359 (11.6%) | |
Residence | 1.000 | ||
Seoul | 2784 (22.5%) | 696 (22.5%) | |
Second area | 2652 (21.4%) | 663 (21.4%) | |
Third area | 6964 (56.2%) | 1741 (56.2%) | |
Household income | 1.000 | ||
Low (0–30%) | 2508 (20.2%) | 627 (20.2%) | |
Middle (30–70%) | 4224 (34.1%) | 1056 (34.1%) | |
High (70–100%) | 5668 (45.7%) | 1417 (45.7%) | |
Comorbidities | 1.000 | ||
No | 2880 (23.2%) | 720 (23.2%) | |
Yes | 9520 (76.8%) | 2380 (76.8%) |
Variables | N | Cases | Incidence | Unadjusted HR (95% CI) | Adjusted HR (95% CI) |
---|---|---|---|---|---|
Group | |||||
Comparison | 12,400 | 775 | 8.8 | 1.00 (ref.) | 1.00 (ref.) |
General anesthesia | 3100 | 240 | 10.5 | 1.52 (1.30–1.76) *** | 1.36 (1.16–1.58) *** |
Sex | |||||
Male | 7180 | 364 | 7.9 | 1.00 (ref.) | 1.00 (ref.) |
Female | 8320 | 651 | 9.9 | 1.20 (1.05–1.36) ** | 1.16 (1.02–1.32) * |
Ages (years) | |||||
55–64 | 8165 | 275 | 3.9 | 1.00 (ref.) | 1.00 (ref.) |
65–74 | 5540 | 554 | 15.4 | 4.25 (3.68–4.91) *** | 3.95 (3.41–4.58) *** |
≥75 | 1795 | 186 | 33.3 | 11.63 (9.63–14.05) *** | 10.08 (8.29–12.26) *** |
Residence | |||||
Seoul | 3480 | 196 | 7.5 | 1.00 (ref.) | 1.00 (ref.) |
Second area | 3315 | 224 | 9.8 | 1.36 (1.12–1.65) ** | 1.27 (1.05–1.54) * |
Third area | 8705 | 595 | 9.6 | 1.31 (1.11–1.54) ** | 1.09 (0.93–1.28) |
Household income | |||||
Low (0–30%) | 3135 | 354 | 13.2 | 1.00 (ref.) | 1.00 (ref.) |
Middle (30–70%) | 5280 | 242 | 6.8 | 0.52 (0.44–0.61) *** | 0.77 (0.65–0.91) ** |
High (70–100%) | 7085 | 419 | 8.6 | 0.65 (0.56–0.75) *** | 0.78 (0.68–0.91) ** |
Comorbidities | |||||
No | 3600 | 90 | 4.8 | 1.00 (ref.) | 1.00 (ref.) |
Yes | 11,900 | 925 | 10.0 | 1.93 (1.55–2.40) *** | 1.54 (1.24–1.92) *** |
Sex | Male | Female | ||
---|---|---|---|---|
Comparison | General Anesthesia | Comparison | General Anesthesia | |
Dementia | ||||
Unadjusted HR (95% CI) | 1.00 (ref.) | 1.33 (1.04–1.71) * | 1.00 (ref.) | 1.66 (1.37–2.00) *** |
Adjusted HR (95% CI) | 1.00 (ref.) | 1.22 (0.95–1.58) | 1.00 (ref.) | 1.44 (1.19–1.75) *** |
Comorbidities | No | Yes | ||
---|---|---|---|---|
Comparison | General Anesthesia | Comparison | General Anesthesia | |
Dementia | ||||
Unadjusted HR (95% CI) | 1.00 (ref.) | 1.43 (0.90–2.28) | 1.00 (ref.) | 1.57 (1.34–1.84) *** |
Adjusted HR (95% CI) | 1.00 (ref.) | 1.04 (0.64–1.68) | 1.00 (ref.) | 1.39 (1.18–1.64) *** |
Variables | N | Cases | Incidence | Unadjusted HR (95% CI) | Adjusted HR (95% CI) |
---|---|---|---|---|---|
Alzheimer’s disease | |||||
Non-anesthesia | 12,400 | 546 | 6.1 | 1.00 (ref.) | 1.00 (ref.) |
General anesthesia | 3100 | 178 | 7.7 | 1.69 (1.41–2.02) *** | 1.52 (1.27–1.82) *** |
Vascular dementia | |||||
Non-anesthesia | 12,400 | 124 | 1.4 | 1.00 (ref.) | 1.00 (ref.) |
General anesthesia | 3100 | 49 | 2.1 | 1.85 (1.31–2.61) *** | 1.64 (1.15–2.33) ** |
Comparison (n = 18,706) | Dementia (n = 9353) | |
---|---|---|
General anesthesia | ||
0 | 16,098 (86.1%) | 7844 (83.9%) |
1 | 2147 (11.5%) | 1204 (12.9%) |
2 | 361 (1.9%) | 239 (2.6%) |
3 | 77 (0.4%) | 50 (0.5%) |
4 | 16 (0.1%) | 9 (0.1%) |
5 | 4 (0.0%) | 4 (0.0%) |
6 | 0 (0.0%) | 2 (0.0%) |
7 | 1 (0.0%) | 0 (0.0%) |
8 | 1 (0.0%) | 0 (0.0%) |
9 | 1 (0.0%) | 0 (0.0%) |
13 | 0 (0.0%) | 1 (0.0%) |
Frequency of General Anesthesia | |
---|---|
Mean | |
Comparison | 0.171 |
Dementia | 0.205 |
Standard deviation | |
Comparison | 0.479 |
Dementia | 0.538 |
Levene test | |
F | 27.327 |
df (v1; v2) | 1; 28,057 |
p-value | 0.000 |
Welch Two Sample t-test | |
t | −5.029 |
df | 16,902 |
p-value | 0.000 |
95% confidence interval | −0.046~−0.020 |
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Sohn, J.-H.; Lee, J.J.; Lee, S.-H.; Kim, C.; Yu, H.; Kwon, Y.-S.; Kim, D.-K. Longitudinal Study of the Association between General Anesthesia and Increased Risk of Developing Dementia. J. Pers. Med. 2021, 11, 1215. https://doi.org/10.3390/jpm11111215
Sohn J-H, Lee JJ, Lee S-H, Kim C, Yu H, Kwon Y-S, Kim D-K. Longitudinal Study of the Association between General Anesthesia and Increased Risk of Developing Dementia. Journal of Personalized Medicine. 2021; 11(11):1215. https://doi.org/10.3390/jpm11111215
Chicago/Turabian StyleSohn, Jong-Hee, Jae Jun Lee, Sang-Hwa Lee, Chulho Kim, Hyunjae Yu, Young-Suk Kwon, and Dong-Kyu Kim. 2021. "Longitudinal Study of the Association between General Anesthesia and Increased Risk of Developing Dementia" Journal of Personalized Medicine 11, no. 11: 1215. https://doi.org/10.3390/jpm11111215
APA StyleSohn, J.-H., Lee, J. J., Lee, S.-H., Kim, C., Yu, H., Kwon, Y.-S., & Kim, D.-K. (2021). Longitudinal Study of the Association between General Anesthesia and Increased Risk of Developing Dementia. Journal of Personalized Medicine, 11(11), 1215. https://doi.org/10.3390/jpm11111215