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. 2023 Sep 25;15(18):9310-9340.
doi: 10.18632/aging.205058. Epub 2023 Sep 25.

Pathways explaining racial/ethnic and socio-economic disparities in dementia incidence: the UK Biobank study

May A Beydoun  1 , Hind A Beydoun  2 , Marie T Fanelli-Kuczmarski  1 , Jordan Weiss  3 , Michael F Georgescu  1 , Osorio Meirelles  1 , Donald M Lyall  4 , Michele K Evans  1 , Alan B Zonderman  1
Affiliations

Pathways explaining racial/ethnic and socio-economic disparities in dementia incidence: the UK Biobank study

May A Beydoun et al. Aging (Albany NY). .

Abstract

Background: Pathways explaining racial/ethnic disparities in dementia risk are under-evaluated.

Methods: We examine those disparities and their related pathways among UK Biobank study respondents (50-74 y, N = 323,483; 3.6% non-White minorities) using a series of Cox proportional hazards and generalized structural equations models (GSEM).

Results: After ≤15 years, 5,491 all-cause dementia cases were diagnosed. Racial minority status (RACE_ETHN, Non-White vs. White) increased dementia risk by 24% (HR = 1.24, 95% CI: 1.07-1.45, P = 0.005), an association attenuated by socio-economic status (SES), (HR = 1.12, 95% CI: 0.96-1.31). Total race-dementia effect was mediated through both SES and Life's Essential 8 lifestyle sub-score (LE8LIFESTYLE), combining diet, smoking, physical activity, and sleep factors. SES was inversely related to dementia risk (HR = 0.69, 95% CI: 0.67, 0.72, P < 0.001). Pathways explaining excess dementia risk among racial minorities included 'RACE_ETHN(-) → SES(-) → DEMENTIA', 'RACE_ETHN(-) → SES(-) → Poor cognitive performance, COGN(+) → DEMENTIA' and 'RACE_ETHN(-) → SES(+) → LE8LIFESTYLE(-) → DEMENTIA'.

Conclusions: Pending future interventions, lifestyle factors including diet, smoking, physical activity, and sleep are crucial for reducing racial and socio-economic disparities in dementia.

Keywords: Alzheimer’s disease; dementia; health disparities; socio-economic status; structural equations modeling.

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Conflict of interest statement

CONFLICTS OF INTEREST: All authors declare no conflict of interest. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of Fort Belvoir Community Hospital, the Defense Health Agency, Department of Defense, or U.S. Government. Reference to any commercial products within this publication does not create or imply any endorsement by Fort Belvoir Community Hospital, the Defense Health Agency, Department of Defense, or U.S. Government.

Figures

Figure 1
Figure 1
Conceptual framework. Abbreviations: ALCOHOL: Alcohol consumption z-score; COGN: Poor cognitive performance, z-score; DIET: Diet quality z-score; HEALTH: Poor cardio-metabolic and general health z-score; LE8BIOLOGICAL: Biological sub-scale of Life’s Essential 8; LE8LIFESTYLE: Lifestyle sub-scale of Life’s Essential 8; LIFESTYLE: Lifestyle factors including DIET, PA, SMOKING, ALCOHOL, NUTR and SS; NUTR: Nutritional biomarker z-score; PA: Physical Activity z-score; SES: Socio-economic status; SMOKING: Smoking z-score; SS: Social Support z-score.
Figure 2
Figure 2
GSEM findings. (A) Model with COGN as a proximal mediator; (B) Model without COGN as a proximal mediator. Abbreviations: COGN: Poor cognitive performance, z-score; LE8BIOLOGICAL: Biological sub-scale of Life’s Essential 8; LE8LIFESTYLE: Lifestyle sub-scale of Life’s Essential 8; SES: Socio-economic status; Red lines: positive associations; Blue lines: inverse associations; Solid line: within hypothesized pathway; Dashed line: outside hypothesized pathway.
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