Deckers, K;
Cadar, D;
van Boxtel, MPJ;
Verhey, FRJ;
Steptoe, A;
Köhler, S;
(2019)
Modifiable Risk Factors Explain Socioeconomic Inequalities in Dementia Risk: Evidence from a Population-Based Prospective Cohort Study.
Journal of Alzheimer's Disease
, 71
(2)
pp. 549-557.
10.3233/jad-190541.
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Abstract
BACKGROUND: Differences in dementia risk across the gradient of socioeconomic status (SES) exist, but their determinants are not well understood. OBJECTIVE: This study investigates whether health conditions and lifestyle-related risk factors explain the SES inequalities in dementia risk. 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). 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). CONCLUSION: Socioeconomic differences in dementia risk can be partly explained by differences in modifiable health conditions and lifestyle factors.
| Type: | Article |
|---|---|
| Title: | Modifiable Risk Factors Explain Socioeconomic Inequalities in Dementia Risk: Evidence from a Population-Based Prospective Cohort Study |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.3233/jad-190541 |
| Publisher version: | https://doi.org/10.3233/JAD-190541 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Aging, cohort study, dementia, epidemiology, health inequalities, lifestyle, mediation, prevention, public health, risk factors, socioeconomic status |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Behavioural Science and Health |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10080282 |
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