Table_1_Dementia Incidence, Burden and Cost of Care: A Filipino Community-Based Study.DOCX

Background: In the midst of competing priorities and limited resources in low-middle-income countries (LMIC), convincing epidemiological evidence is critical for urging governments to develop national dementia plans. The majority of primary epidemiological studies on dementia are from high income countries (HIC). Implications for developing countries are typically extrapolated from these outcomes through modeling, meta-analyses, and systematic reviews. In this study, we directly assessed the incidence of dementia, disability adjusted life years (DALYs), and cost of care among community-dwelling Filipino elderly.
Methods: This was a follow-up study of the prospective cohort Marikina Memory Ageing Project (MMAP). Baseline assessment was performed in 2011–2012, and follow-up was done in 2015–2016 (N = 748 at follow-up). Incident dementia was determined. Disease burden was computed using the incidence rates and DALYs. Both indirect and direct (medical and non-medical) costs of dementia care were computed.
Results: The crude incidence rate was 16 (CI: 13–20) cases per 1,000 person-years (pyr) with 17 (CI: 12–21) per 1,000 pyr for females and 14 (CI: 9–21) per 1,000 pyr for males. Based on this incidence, we project an estimation of 220,632 new cases in 2030, 295,066 in 2040, and 378,461 in 2050. Disease burden was at 2,876 DALYsper 100,000 persons. The economic burden per patient was around Php 196,000 annually (i.e., ~4,070 USD, or 36.7% of average family annual income in the Philippines). The majority (86.29%) of this care expense was indirect cost attributed to estimated lost potential earning of unpaid family caregivers whereas direct medical cost accounted for only 13.48%.
Conclusions: We provide the first Filipino community-based data on the incidence of dementia, DALYs, and cost of care to reflect the epidemiologic and economic impact of disease. The findings of this study serve to guide the development of a national dementia plan.

背景：中低收入国家（low-middle-income countries, LMIC）面临多重优先级冲突与资源有限的困境，亟需确凿的流行病学证据以推动政府制定国家痴呆防治规划。当前绝大多数痴呆原创性流行病学研究均来自高收入国家（high income countries, HIC），发展中国家的相关应用依据通常通过建模、荟萃分析与系统综述从上述研究结果外推得到。本研究直接评估了社区居住的菲律宾老年人群的痴呆发病率、伤残调整生命年（Disability Adjusted Life Years, DALYs）及照护成本。

方法：本研究为前瞻性队列“马里基纳记忆衰老项目（Marikina Memory Ageing Project, MMAP）”的随访研究。基线评估于2011–2012年开展，随访评估于2015–2016年完成（随访时有效样本量为748例）。研究判定了新发痴呆病例，以发病率与伤残调整生命年计算疾病负担，并同时计算痴呆照护的间接成本与直接成本（含医疗与非医疗成本）。

结果：粗发病率为每1000人年（person-years, pyr）16例（95%置信区间CI：13–20），其中女性为每1000人年17例（CI：12–21），男性为每1000人年14例（CI：9–21）。基于该发病率，我们预测2030年、2040年与2050年的新发痴呆病例数将分别达到220632例、295066例与378461例。本研究的疾病负担为每10万人2876个伤残调整生命年。每位患者的年经济负担约为196000菲律宾比索（约合4070美元，占菲律宾家庭年均收入的36.7%）。该照护成本中绝大多数（86.29%）为间接成本，主要源于无偿家庭照护者的潜在收入损失，而直接医疗成本仅占13.48%。

结论：本研究首次提供了菲律宾社区人群的痴呆发病率、伤残调整生命年及照护成本数据，以反映该疾病的流行病学与经济影响。本研究结果可为国家痴呆防治规划的制定提供科学参考。