Association of Socioeconomic Status With Dementia Diagnosis Among Older Adults in Denmark

Abstract

IMPORTANCE Low socioeconomic status (SES) has been identified as a risk factor for the development of dementia. However, few studies have focused on the association between SES and dementia diagnostic evaluation on a population level. OBJECTIVE To investigate whether household income (HHI) is associated with dementia diagnosis and cognitive severity at the time of diagnosis. DESIGN, SETTING, AND PARTICIPANTS This population-and register-based cross-sectional study analyzed health, social, and economic data obtained from various Danish national registers. The study population comprised individuals who received a first-time referral for a diagnostic evaluation for dementia to the secondary health care sector of Denmark between January 1, 2017, and December 17, 2018. Dementia-related health data were retrieved from the Danish Quality Database for Dementia. Data analysis was conducted from October 2019 to December 2020. EXPOSURES Annual HHI (used as a proxy for SES) for 2015 and 2016 was obtained from Statistics Denmark and categorized into upper, middle, and lower tertiles within 5-year interval age groups. MAIN OUTCOMES AND MEASURES Dementia diagnoses (Alzheimer disease, vascular dementia, mixed dementia, dementia with Lewy bodies, Parkinson disease dementia, or other) and cognitive stages at diagnosis (cognitively intact; mild cognitive impairment but not dementia; or mild, moderate, or severe dementia) were retrieved from the database. Univariable and multivariable logistic and linear regressions adjusted for age group, sex, region of residence, household type, period (2017 and 2018), medication type, and medical conditions were analyzed for a possible association between HHI and receipt of dementia diagnosis. RESULTS Among the 10 191 individuals (mean [SD] age, 75 [10] years; 5476 women [53.7%])included in the study, 8844 (86.8%) were diagnosed with dementia. Individuals with HHI in the upper tertile compared with those with lower-tertile HHI were less likely to receive a dementia diagnosis after referral (odds ratio, 0.65; 95% CI, 0.55-0.78) and, if diagnosed with dementia, had less severe cognitive stage (β, −0.16; 95% CI, −0.21 to −0.10). Individuals with middle-tertile HHI did not significantly differ from those with lower-tertile HHI in terms of dementia diagnosis (odds ratio, 0.92; 95% CI, 0.77-1.09) and cognitive stage at diagnosis (β, 0.01; 95% CI, −0.04 to 0.06). CONCLUSIONS AND RELEVANCEThe results of this study revealed a social inequality in dementia diagnostic evaluation: in Denmark, people with higher income seem to receive an earlier diagnosis.Public health strategies should target people with lower SES for earlier dementia detection and intervention.

Association between depression and the risk of Alzheimer’s disease using the Korean National Health Insurance Service-Elderly Cohort

“…These results probably due to the distinct association between socioeconomic status and dementia that low income group already had higher prevalence of Alzheimer’s disease, thus depression had lower risk elevation than higher income groups 26 . Additionally, Petersen et al suggested that higher income people seems to receive dementia diagnosis earlier than lower socioeconomic status group which can also explain our results 27 .…”

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“…In all years, the proportion of incident dementia cases was highest in individuals within the highest income group (top 20%). Although previous reports show an association between dementia and lower socioeconomic status [20,21], high-income individuals perhaps are more aware of their cognitive change, continue to consult their physicians and take cognitive function tests, and receive an earlier diagnosis [22]. However, the proportion of incident dementia in individuals within the lowest income group (bottom 20%) increased steadily from 20.4% in 2007 to 25.8% in 2011 (Tables 2 and 3, and Figure 2).…”

Socioeconomic Position and Late-Onset Dementia: A Nationwide Register-Based Study

“…The duration of our study period may also have caused an underestimation in rate differences across socioeconomic positions as studies indicate an increased incidence of dementia beyond the maximum age in this study of 83 years (Livingston et al, 2017; Taudorf et al, 2019). This assumed underestimation may be exacerbated by those with higher socioeconomic position being diagnosed earlier as indicated by a recent Danish study (Petersen et al, 2021). Conversely, our findings may also be overestimated due to social inequality in morbidity and thereby contact to the health-care sector, that is, detection bias.…”