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Multicenter Study
. 2019;71(2):549-557.
doi: 10.3233/JAD-190541.

Modifiable Risk Factors Explain Socioeconomic Inequalities in Dementia Risk: Evidence from a Population-Based Prospective Cohort Study

Kay Deckers  1 , Dorina Cadar  2 , Martin P J van Boxtel  1 , Frans R J Verhey  1 , Andrew Steptoe  2   3 , Sebastian Köhler  1
Affiliations
Multicenter Study

Modifiable Risk Factors Explain Socioeconomic Inequalities in Dementia Risk: Evidence from a Population-Based Prospective Cohort Study

Kay Deckers et al. J Alzheimers Dis. 2019.

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.

Keywords: Aging; cohort study; dementia; epidemiology; health inequalities; lifestyle; mediation; prevention; public health; risk factors; socioeconomic status.

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Conflict of interest statement

Authors’ disclosures available online (https://www.j-alz.com/manuscript-disclosures/19-0541r2).

Figures

Fig.1
Fig.1
The cumulative hazard of dementia over time in study by LIBRA score tertiles.
Fig.2
Fig.2
The cumulative hazard of dementia over time in study by wealth tertiles.
Fig.3
Fig.3
Mediation analysis for the relationship between wealth and dementia as mediated by LIBRA. B, unstandardized regression coefficient; HR, hazard ratio; SE, standard error.
See this image and copyright information in PMC

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