Jeffrey F Scherrer1,2,3, Joanne Salas1,2,3, Timothy L Wiemken3,4,5,6, Christine Jacobs1,3, John E Morley7, Daniel F Hoft5,6,8. 1. Department of Family and Community Medicine, Saint Louis University School of Medicine, Missouri, USA. 2. Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri, USA. 3. The AHEAD Institute, Saint Louis University School of Medicine, Missouri, USA. 4. Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, Missouri, USA. 5. Division of Infectious Diseases, Allergy, and Immunology, Department of Internal Medicine, Saint Louis University School of Medicine, Missouri, USA. 6. Saint Louis University Systems Infection Prevention Center, Center for Specialized Medicine, Missouri, USA. 7. Division of Geriatric Medicine, Saint Louis University School of Medicine, Missouri, USA. 8. Departments of Internal Medicine and Molecular Microbiology and Immunology, Saint Louis University, Missouri, USA.
Abstract
BACKGROUND: Adult vaccinations may reduce risk for dementia. However, it has not been established whether tetanus, diphtheria, pertussis (Tdap) vaccination is associated with incident dementia. METHODS: Hypotheses were tested in a Veterans Health Affairs (VHA) cohort and replicated in a MarketScan medical claims cohort. Patients were at least 65 years of age and free of dementia for 2 years prior to index date. Patients either had or did not have a Tdap vaccination by the start of either of the 2 index periods (2011 or 2012). Follow-up continued through 2018. Controls had no Tdap vaccination for the duration of follow-up. Confounding was controlled using entropy balancing. Competing risk (VHA) and Cox proportional hazard (MarketScan) models estimated the association between Tdap vaccination and incident dementia in all patients and age subgroups (65-69, 70-74, and ≥75 years). RESULTS: VHA patients were, on average, 75.6 (SD ± 7.5) years of age, 4% female, and 91.2% were White. MarketScan patients were 69.8 (SD ± 5.6) years of age, on average and 65.4% were female. After controlling for confounding, patients with, compared to without, Tdap vaccination had a significantly lower risk for dementia in both cohorts (VHA: hazard ratio [HR] = 0.58; 95% confidence interval [CI]:0.54-0.63 and MarketScan: HR = 0.58; 95% CI:0.48-0.70). CONCLUSIONS: Tdap vaccination was associated with a 42% lower dementia risk in 2 cohorts with different clinical and sociodemographic characteristics. Several vaccine types are linked to decreased dementia risk, suggesting that these associations are due to nonspecific effects on inflammation rather than vaccine-induced pathogen-specific protective effects.
BACKGROUND: Adult vaccinations may reduce risk for dementia. However, it has not been established whether tetanus, diphtheria, pertussis (Tdap) vaccination is associated with incident dementia. METHODS: Hypotheses were tested in a Veterans Health Affairs (VHA) cohort and replicated in a MarketScan medical claims cohort. Patients were at least 65 years of age and free of dementia for 2 years prior to index date. Patients either had or did not have a Tdap vaccination by the start of either of the 2 index periods (2011 or 2012). Follow-up continued through 2018. Controls had no Tdap vaccination for the duration of follow-up. Confounding was controlled using entropy balancing. Competing risk (VHA) and Cox proportional hazard (MarketScan) models estimated the association between Tdap vaccination and incident dementia in all patients and age subgroups (65-69, 70-74, and ≥75 years). RESULTS: VHA patients were, on average, 75.6 (SD ± 7.5) years of age, 4% female, and 91.2% were White. MarketScan patients were 69.8 (SD ± 5.6) years of age, on average and 65.4% were female. After controlling for confounding, patients with, compared to without, Tdap vaccination had a significantly lower risk for dementia in both cohorts (VHA: hazard ratio [HR] = 0.58; 95% confidence interval [CI]:0.54-0.63 and MarketScan: HR = 0.58; 95% CI:0.48-0.70). CONCLUSIONS: Tdap vaccination was associated with a 42% lower dementia risk in 2 cohorts with different clinical and sociodemographic characteristics. Several vaccine types are linked to decreased dementia risk, suggesting that these associations are due to nonspecific effects on inflammation rather than vaccine-induced pathogen-specific protective effects.
Authors: Timothy L Wiemken; Joanne Salas; John E Morley; Daniel F Hoft; Christine Jacobs; Jeffrey F Scherrer Journal: J Am Geriatr Soc Date: 2021-12-12 Impact factor: 7.538
Authors: Avram S Bukhbinder; Yaobin Ling; Omar Hasan; Xiaoqian Jiang; Yejin Kim; Kamal N Phelps; Rosemarie E Schmandt; Albert Amran; Ryan Coburn; Srivathsan Ramesh; Qian Xiao; Paul E Schulz Journal: J Alzheimers Dis Date: 2022 Impact factor: 4.160