公共卫生研究摘要 (2026-02-12)

共收录 62 篇研究文章

1. Five-Year Follow-Up of Work Disability After Traumatic Brain Injury: A Nationwide Swedish Matched Cohort Study of 98,000 Individuals.

期刊: Neurology 发表日期: 2026-Mar-10 链接: PubMed

摘要

Traumatic brain injury (TBI) is a leading cause of long-term disability in working-age populations. Return to work is a key marker of recovery, yet most studies assess it as binary at fixed time points. We aimed to estimate transition probabilities to and from work disability during 5 years after TBI and how injury severity and preinjury sociodemographic and medical factors influence these probabilities. We conducted a nationwide matched cohort study in Sweden using linked registers. Individuals aged 21-60 years with a TBI diagnosis between 2005 and 2016 were compared with up to 10 matched non-TBI individuals. TBI severity was proxied by care characteristics: TBI A (emergency visit or ≤2 days), TBI B (≥3 days), and TBI C (neurosurgery). Transition probabilities to and from work disability (>14 days sickness absence) were estimated with multistate models. Sociodemographic and medical factors were assessed with Cox regression. The cohort included 98,256 individuals with TBI and 981,191 matched non-TBI individuals (median age 39 years; 43% women). Transition probabilities to work disability were higher in all TBI groups: at 30 days, 5.5% (95% CI 5.4-5.7) for TBI A, 29% (28.0-30.7) for TBI B, and 43% (38.2-47.3) for TBI C, vs 0.5% (0.5-0.6) in non-TBI; at 5 years, 7.1% (7.0-7.3), 10.9% (10.2-11.7), and 12.9% (10.7-15.7), vs 4.0% (4.0-4.1). In TBI A and B, higher probability was predicted by older age (TBI A hazard ratio 1.23, 95% CI 1.20-1.26; TBI B 1.34, 1.21-1.48), female sex (TBI A 1.59, 1.56-1.62; TBI B 1.35, 1.26-1.44), and psychiatric disorders (TBI A 1.34, 1.30-1.39; TBI B 1.28, 1.11-1.48), while higher education (TBI A 0.83, 0.81-0.86) and city residence (TBI A 0.92, 0.90-0.95; TBI B 0.88, 0.80-0.95) were protective. In TBI C, only older age remained significant (1.59, 1.17-2.14). TBI was associated with persistently elevated transition probabilities to work disability across all severity groups, with early peaks in TBI B and C and a delayed increase in TBI A, influenced by sociodemographic and medical factors. However, the lack of standardized severity grading limits comparison with other studies. Still, these results suggest TBI increases long-term risk of work disability, supporting sustained individualized rehabilitation.

2. Associations of Lifetime Cognitive Enrichment With Incident Alzheimer Disease Dementia, Cognitive Aging, and Cognitive Resilience.

期刊: Neurology 发表日期: 2026-Mar-10 链接: PubMed

摘要

The effects of lifetime cognitive enrichment on later-life cognitive outcomes are not comprehensively investigated. The aim of this study was to test the association of lifetime cognitive enrichment with Alzheimer disease (AD) dementia and cognitive decline and in an autopsied deceased subset to explore the association between lifetime enrichment and AD and related dementia (ADRD) pathologic indices and cognitive resilience that is, decline after adjusting for common ADRD pathologies. This was a longitudinal clinicopathologic study involving older individuals from Northeastern Illinois who participated in the Rush Memory and Aging Project, were free of dementia at baseline, completed surveys reflecting lifetime enrichment, and had annual clinical evaluations. We constructed a composite measure reflecting lifetime cognitive enrichment and tested its association with incident AD dementia in proportional hazards models, mean age of AD dementia onset in an accelerated failure time model, and cognitive decline using linear mixed-effects models. In a deceased subset, we tested the association of lifetime cognitive enrichment with 9 ADRD pathologies and cognitive resilience. Participants (n = 1,939, 75% female, mean baseline age = 79.6) completed an average of 7.6 years of follow-up, during which 551 participants developed AD dementia. One unit higher in lifetime enrichment was associated with 38% lower hazards of developing AD dementia (hazard ratio 0.62, 95% CI 0.52-0.73, p < 0.001). High lifetime enrichment (90th percentile) compared with low (10th percentile) was associated with a mean of 5 years delayed onset of AD dementia. Lifetime enrichment was positively associated with cognitive function at baseline (estimate = 0.31, SE = 0.02, p < 0.001) and a slower rate of cognitive decline (estimate = 0.02, SE = 0.01, p = 0.002). In the deceased subset (n = 948), lifetime cognitive enrichment did not show meaningful associations with neuropathologic indices, but remained associated with higher cognitive function proximate to death (estimate = 0.32, SE = 0.06, p < 0.001) and a slower rate of cognitive decline after adjusting for pathology (estimate = 0.014, SE = 0.01, p = 0.02). Lifetime exposure to cognitive enrichment was related to lower risk of AD dementia and a slower rate of cognitive decline, including after adjustment for common ADRD pathologies, indicating higher resilience provided by lifetime enrichment. Our results suggest that cognitive health in later life is in part the product of lifetime exposure to cognitive enrichment.

3. A Roadmap to Neurologic Health Equity: An AAN Position Statement.

期刊: Neurology 发表日期: 2026-Mar-10 链接: PubMed

摘要

Neurologic disorders affect more than 200 million people in the United States, yet inequities in neurologic health persist particularly among marginalized populations. These disparities are rooted not in biological differences but in inequitable social, economic, and structural conditions and result in disproportionate disease burden, delayed diagnoses, restricted access to specialty care, and subpar brain health outcomes for populations experiencing health disparities (HDPs). Existing national health equity frameworks from the NIH demonstrate that neurologic inequities are shaped by intersecting social determinants of health (SDOH) and structural barriers that limit fair and just opportunities to achieve optimal brain health. In response, the American Academy of Neurology (AAN) proposes a comprehensive Roadmap to Neurologic Health Equity, grounded in the principle that every individual should have the opportunity to attain their highest level of brain health. The AAN roadmap provides a coordinated strategy to address health inequity across 4 domains: (1) Clinical Practice and Quality, (2) Scientific Knowledge and Research, (3) Education and Awareness, and (4) Advocacy. For clinical practice, the roadmap emphasizes integrating SDOH into clinical care delivery, expanding language services and culturally responsive models, and advancing workforce diversity to better reflect and serve diverse communities. Research priorities include strengthening rigor in disparities research, increasing participation of HDPs in clinical studies, and expanding training pathways for investigators committed to health equity. Educational initiatives focus on embedding health equity content throughout neurology curricula, enhancing clinician awareness of health disparities through AAN programming, and strengthening communication skills necessary for effective community engagement. The policy and advocacy framework targets systemic reforms such as expanding insurance coverage, improving reimbursement for complex neurologic care, investing in telehealth infrastructure, and addressing the national neurology workforce shortage through increased Graduate Medical Education funding and secure immigration pathways for international neurologists willing to serve in underserved areas. Together, these strategies provide a unified, actionable approach to advancing brain health equity across the lifespan. The AAN calls upon clinicians, researchers, educators, policymakers, and community advocates to join in implementing this roadmap and ensuring that the pursuit of optimal brain health is attainable and equitable for all.