Midlife socioeconomic position and old-age dementia mortality: a large prospective register-based study from Finland

Korhonen, Kaarina; Einiö, Elina; Leinonen, Taina; Tarkiainen, Lasse; Martikainen, Pekka

doi:10.1136/bmjopen-2019-033234

Cited by 31 publications

(23 citation statements)

References 25 publications

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“…These findings add to mounting evidence that socioeconomic status is an important determinant of dementia risk (2)(3)(4)(5)(6) . Although a direct causal relationship between socioeconomic status and dementia has yet to be established, stratification of other dementia risk factors within more deprived groups would still suggest that deprivation could be a major target in public health approaches aimed at reducing the population burden of dementia.…”

Section: Discussionsupporting

confidence: 58%

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The Influence of Socioeconomic Deprivation on Dementia Mortality, Age at Death, and Quality of Diagnosis: A Nationwide Death Records Study in England and Wales 2001–2017

Jitlal

Amirthalingam

Karania

et al. 2021

JAD

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Background: Socioeconomic deprivation may be an important determinant of dementia risk, mortality, and access to diagnostic services. Premature mortality from other causes and under-representation of deprived individuals in research may lead to this effect being overlooked. Objective: We assessed the relationship between deprivation and dementia mortality using comprehensive death certificate data for England and Wales from 2001 to 2017. Methods: We used standardized mortality ratios (SMR) and a Poisson model to compare likelihood of dying from dementia in each deprivation decile. We also examined the associations of deprivation with age at death from dementia, and with likelihood of receiving a diagnosis of unspecified dementia. Results: Risk of dying from dementia was higher in more deprived deciles (Mean SMR [95% CI] in decile 1 : 0.528 [0.506 to 0.550], decile 10:0.369 [0.338 to 0.400]). In 2017, 14,837 excess dementia deaths were attributable to deprivation (21.5% of all dementia deaths that year). There were dose-response associations of deprivation with likelihood of being older at death with dementia (odds ratio [95% CI] for decile 10 (least deprived): 1.31 [1.28 to 1.33] relative to decile 1), and with likelihood of receiving a diagnosis of unspecified dementia (odds ratio [95% CI] for decile 10:0.78 [0.76 to 0.80] relative to decile 1). Conclusion: Socioeconomic deprivation in England and Wales is associated with increased dementia mortality, younger age at death with dementia, and poorer access to specialist diagnosis. Reducing social inequality may have a role in the prevention of dementia mortality.

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Section: Discussionsupporting

confidence: 58%

“…However, the association of this with dementia mortality across the United Kingdom has not been systematically examined. Socioeconomic deprivation has previously been shown to be a risk factor for dementia (2)(3)(4)(5)(6) .…”

Section: Introductionmentioning

confidence: 99%

The Influence of Socioeconomic Deprivation on Dementia Mortality, Age at Death, and Quality of Diagnosis: A Nationwide Death Records Study in England and Wales 2001–2017

Jitlal

Amirthalingam

Karania

et al. 2021

JAD

View full text Add to dashboard Cite

show abstract

“…These findings add to mounting evidence that socioeconomic status is an important determinant of dementia risk (2)(3)(4)(5)(6) . Our results highlight that deprivation should be considered a major target in public health approaches aimed at reducing the population burden of dementia.…”

Section: Discussionsupporting

confidence: 58%

“…Socioeconomic deprivation has previously been shown to be a risk factor for dementia (2)(3)(4)(5)(6) .…”

Section: Introductionmentioning

confidence: 99%

The influence of socioeconomic deprivation on dementia mortality, age at death and quality of diagnosis: a nationwide death records study in England and Wales 2001-2017

Jitlal

Amirthalingam

Karania

et al. 2020

Preprint

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Background. Socioeconomic deprivation is postulated to be an important determinant of dementia risk, mortality, and access to diagnostic services. Nevertheless, premature mortality from other causes and under-representation of deprived individuals in research cohorts may lead to this effect being overlooked. Methods. We obtained Office of National Statistics (ONS) mortality data where dementia was recorded as a cause of death in England and Wales from 2001 to 2017, stratified by age, diagnosis code and UK Index of Multiple Deprivation (IMD) decile. We calculated standardised mortality ratios (SMR) for each IMD decile, adjusting for surviving population size in each IMD decile and age stratum. In those who died of dementia, we used ordinal logistic regression to examine the effect of deprivation on likelihood of being older at death. We used logistic regression to test the effect of deprivation on likelihood of receiving a diagnosis of unspecified dementia, a proxy for poor access to specialist diagnostic care. Results. 578,623 deaths due to dementia in people over the age of 65 were identified between 2001-2017. SMRs were similar across the three most deprived deciles (1-3) but progressively declined through deciles 4-10 (Mean SMR [95%CI] in decile 1: 0.528 [0.506 to 0.550], decile 10: 0.369 [0.338 to 0.400]). This effect increased over time with improving ascertainment of dementia. In 2017, 14,837 excess dementia deaths were attributable to deprivation (21.5% of the total dementia deaths that year). There were dose-response effects of deprivation on likelihood of being older at death with dementia (odds ratio [95%CI] for decile 10 (least deprived): 1.31 [1.28 to 1.33] relative to decile 1), and on likelihood of receiving a diagnosis of unspecified dementia (odds ratio [95%CI] for decile 10: 0.78 [0.76 to 0.80] relative to decile 1). Conclusions. Socioeconomic deprivation in England and Wales is associated with increased dementia mortality, younger age at death with dementia, and poorer access to specialist diagnosis. Reducing social inequality may be an important strategy for prevention of dementia mortality.

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“…[3][4][5][6][7] Socioeconomic status (SES), commonly measured by educational level, income level, and occupation, has been recognized as a risk factor for dementia and dementia-related death given that low SES was found to be associated with an increased risk for both. [8][9][10][11][12][13] Aside from studies on the risk of developing dementia, few studies have focused on SES and its association with dementia diagnosis and cognitive severity at diagnosis. Findings of such studies generally showed that lower SES was associated with a higher risk of receiving a dementia diagnosis and lower cognitive function at the time of diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Midlife socioeconomic position and old-age dementia mortality: a large prospective register-based study from Finland

Cited by 31 publications

References 25 publications

The Influence of Socioeconomic Deprivation on Dementia Mortality, Age at Death, and Quality of Diagnosis: A Nationwide Death Records Study in England and Wales 2001–2017

The Influence of Socioeconomic Deprivation on Dementia Mortality, Age at Death, and Quality of Diagnosis: A Nationwide Death Records Study in England and Wales 2001–2017

The influence of socioeconomic deprivation on dementia mortality, age at death and quality of diagnosis: a nationwide death records study in England and Wales 2001-2017

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

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