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Modifiable Risk Factors Explain Socioeconomic Inequalities in Dementia Risk: Evidence from a Population-Based Prospective Cohort Study.
- Source :
-
Journal of Alzheimer's disease : JAD [J Alzheimers Dis] 2019; Vol. 71 (2), pp. 549-557. - Publication Year :
- 2019
-
Abstract
- Background: Differences in dementia risk across the gradient of socioeconomic status (SES) exist, but their determinants are not well understood.<br />Objective: This study investigates whether health conditions and lifestyle-related risk factors explain the SES inequalities in dementia risk.<br />Methods: 6,346 participants from the English Longitudinal Study of Ageing were followed up from 2008/2009 until 2014/2015. We used Cox regression adjusted for age, gender, wealth/education, and clustering at the household level to examine the association between SES markers (wealth, education) and time to dementia in a structural equation model including potential mediation or effect modification by a weighted compound score of twelve modifiable risk and protective factors for dementia ('LIfestyle for BRAin health' (LIBRA) score).<br />Results: During a median follow-up of 6 years, 192 individuals (3.0%) developed dementia. LIBRA scores decreased with increasing wealth and higher educational level. A one-point increase in the LIBRA score was associated with a 13% increase in dementia risk (hazard ratio (HR) = 1.13, 95% confidence interval 1.07-1.19). Higher wealth was associated with a decreased dementia risk (HR = 0.58, 0.39-0.85). Mediation analysis showed that 52% of the risk difference between the highest and lowest wealth tertile was mediated by differences in LIBRA (indirect effect: HR = 0.75, 0.66-0.85). Education was not directly associated with dementia (HR = 1.05, 0.69-1.59), but was a distal risk factor for dementia by explaining differences in wealth and LIBRA scores (indirect effect high education: HR = 0.92, 0.88-0.95).<br />Conclusion: Socioeconomic differences in dementia risk can be partly explained by differences in modifiable health conditions and lifestyle factors.
- Subjects :
- Aged
Aged, 80 and over
Cohort Studies
Dementia therapy
Female
Follow-Up Studies
Humans
Longitudinal Studies
Male
Middle Aged
Prospective Studies
Risk Factors
Risk Reduction Behavior
Dementia economics
Dementia epidemiology
Healthcare Disparities economics
Healthcare Disparities trends
Population Surveillance
Social Class
Subjects
Details
- Language :
- English
- ISSN :
- 1875-8908
- Volume :
- 71
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Journal of Alzheimer's disease : JAD
- Publication Type :
- Academic Journal
- Accession number :
- 31424404
- Full Text :
- https://doi.org/10.3233/JAD-190541