Secular trends of mortality and dementia-free life expectancy over a 10-year period in France
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The aim of this paper was to investigate the evolution of mortality and life expectancy according to dementia in two French populations 10 years apart. Two different populations of subjects aged 65 or older included in PAQUID from 1988 to 1989 (n = 1342) and 3C from 1999 to 2000 (n = 1996) and initially not demented were followed over 10 years. Dementia was assessed using an algorithmic approach, and participants were considered to have dementia if they had an MMSE score < 24 AND a 4IADL score > 1. Illness-death models were used to compare mortality with and without dementia and to provide total life expectancy (LE), dementia-free life expectancy (DemFreeLE), life expectancy with dementia (DemLE), and survival with dementia. Mortality without dementia has decreased between the two populations among men [HR = 0.63 (0.49–0.81)] and women [HR = 0.67 (0.50–0.90)], whereas mortality with dementia has decreased for women only [HR = 0.59 (0.41–0.87)]. Total LE and DemFreeLE have increased between the 1990s and the 2000s populations (total LE: + 2.5 years; DemFreeLE: + 2.2 years); DemLE only slightly increased between the populations (DemLE: + 0.3 years). For survival with dementia, an increase in survival has been evidenced (mean survival: + 1.3 years) for women only. The improvement in DemFreeLE is promising. However, as the duration of life with dementia tends to increase for women, efforts to delay the onset of dementia should be reinforced.
KeywordsSecular trends Dementia Mortality Life expectancy
The PAQUID study was funded by IPSEN France, NOVARTIS Pharma France, and the CNSA (Caisse Nationale de Solidarité et d’Autonomie). The Three-City study is conducted under a partnership agreement between the Institut National de la Santé et de la Recherche Médicale (INSERM), the University Bordeaux 2 Victor Segalen and Sanofi-Aventis. The Fondation pour la Recherche Médicale funded the preparation and initiation of the study. The Three-City study is also supported by the Caisse Nationale d’Assurance Maladie des Travailleurs Salariés, Direction Générale de la Santé, MGEN, Institut de la Longévité, Conseils Régionaux d’Aquitaine et Bourgogne, Fondation de France, Ministry of Research-INSERM Programme “Cohortes et collections de données biologiques”, Agence Nationale de la Recherche ANR PNRA 2006 and LongVie 2007, the “Fondation Plan Alzheimer” (FCS 2009-2012) and the CNSA (Caisse Nationale de Solidarité et d’Autonomie).
Compliance with ethical standards
Conflict of interest
Leslie Grasset, Karine Pérès, Pierre Joly, Camille Sabathé, Alexandra Foubert-Samier and Catherine Helmer declare that they have no conflict of interest. Jean François Dartigues has received research Grants from IPSEN and Roche, outside the submitted work.
Informed consent was obtained from all individual participants included in the study.
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