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

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 (LE8 LIFESTYLE ), 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(+) → LE8 LIFESTYLE (−) → 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.

Pathways explaining racial/ethnic and socio-economic disparities in brain white matter integrity outcomes in the UK Biobank study

“…In the UK, racial/ethnic and socio-economic disparities in Alzheimer’s disease (AD) and dementia risk and their determinants remain unclear and underexplored, although recent work point to the central role played by SES and lifestyle factors when it comes to racial/ethnic disparities in dementia incidence in the UK (M. A. Beydoun et al, 2023a ). Similarly, pathways explaining racial/ethnic and socio-economic disparities in brain markers of the dementia phenome, including reduced WMI, are under-studied.…”