Socioeconomic Deprivation, Genetic Risk, and Incident Dementia

Klee, Matthias; Leist, Anja; Veldsman, Michele; Ranson, Janice M; Llewellyn, David J.

doi:10.1016/j.amepre.2023.01.012

Cited by 13 publications

(10 citation statements)

References 46 publications

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“…This pattern has also been observed in dementia 21 28 34 35. Further, this link has also been explored in genetic biobank studies and have found the same conclusion 15 36. However, it is possible that this correlation between deprivation and AD diagnosis may be even stronger in magnitude compared with the results of this analysis due to underdiagnosis.…”

Section: Discussionsupporting

confidence: 68%

“…Multiple studies have been conducted to assess the occurrence and extent of AD and dementia more generally 12–17. One such study performed a comprehensive analysis of published data from various regions and stages of AD 13.…”

Section: Introductionmentioning

confidence: 99%

“…Other risk factors commonly associated with AD and dementia include genetics, such as the APOE-e4 gene and family history, such as those having first-degree relatives with AD 18 19. Additionally, it has been suggested that regions with significant socioeconomic deprivation and lifestyle factors such as physical activity, diet and smoking may be associated with an elevated risk of dementia 15 20 21…”

Section: Introductionmentioning

confidence: 99%

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Estimating the prevalence of diagnosed Alzheimer disease in England across deprivation groups using electronic health records: a clinical practice research datalink study

Leahy,

Simpson,

Sammon

et al. 2023

BMJ Open

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ObjectiveEstimate the prevalence of diagnosed Alzheimer’s disease (AD) and early Alzheimer’s disease (eAD) overall and stratified by age, sex and deprivation and combinations thereof in England on 1 January 2020.DesignCross-sectional.SettingPrimary care electronic health record data, the Clinical Practice Research database linked with secondary care data, Hospital Episode Statistics (HES) and patient-level deprivation data, Index of Multiple Deprivation (IMD).Outcome measuresThe prevalence per 100 000 of the population and corresponding 95% CIs for both diagnosed AD and eAD overall and stratified by covariates. Sensitivity analyses were conducted to assess the sensitivity of the population definition and look-back period.ResultsThere were 448 797 patients identified in the Clinical Practice Research Datalink that satisfied the study inclusion criteria and were eligible for HES and IMD linkage. For the main analysis of AD and eAD, 379 763 patients are eligible for inclusion in the denominator. This resulted in an estimated prevalence of diagnosed AD of 378.39 (95% CI, 359.36 to 398.44) per 100 000 and eAD of 292.81 (95% CI, 276.12 to 310.52) per 100 000. Prevalence estimates across main and sensitivity analyses for the entire AD study population were found to vary widely with estimates ranging from 137.48 (95% CI, 127.05 to 148.76) to 796.55 (95% CI, 768.77 to 825.33). There was significant variation in prevalence of diagnosed eAD when assessing the sensitivity with the look-back periods, as low as 120.54 (95% CI, 110.80 to 131.14) per 100 000, and as high as 519.01 (95% CI, 496.64 to 542.37) per 100 000.ConclusionsThe study found relatively consistent patterns of prevalence across both AD and eAD populations. Generally, the prevalence of diagnosed AD increased with age and increased with deprivation for each age category. Women had a higher prevalence than men. More granular levels of stratification reduced patient numbers and increased the uncertainty of point prevalence estimates. Despite this, the study found a relationship between deprivation and prevalence of AD.

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Section: Discussionsupporting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Estimating the prevalence of diagnosed Alzheimer disease in England across deprivation groups using electronic health records: a clinical practice research datalink study

Leahy,

Simpson,

Sammon

et al. 2023

BMJ Open

View full text Add to dashboard Cite

show abstract

“…found that area‐level socioeconomic deprivation (air pollution, green spaces, etc.) was predictive of dementia, even after adjustment for individual‐level socioeconomic deprivation (e.g., household income and housing type) 104 . Mediation analysis within the English Longitudinal Study of Ageing also showed that the dementia risk (based on an algorithm combining physician diagnosis, self‐report, and informant report) difference between the highest and lowest wealth tertile was 52% mediated by differences in LIBRA scores, highlighting the importance of socioeconomic position in dementia risk reduction 20 .…”

Section: Resultsmentioning

confidence: 95%

“…was predictive of dementia, even after adjustment for individual‐level socioeconomic deprivation (e.g., household income and housing type). 104 Mediation analysis within the English Longitudinal Study of Ageing also showed that the dementia risk (based on an algorithm combining physician diagnosis, self‐report, and informant report) difference between the highest and lowest wealth tertile was 52% mediated by differences in LIBRA scores, highlighting the importance of socioeconomic position in dementia risk reduction. 20 As such, reducing social inequalities by targeting factors on both the individual and area level could play an important part in public health strategies addressing brain health.…”

Section: Resultsmentioning

confidence: 99%

Umbrella review and Delphi study on modifiable factors for dementia risk reduction

Rosenau,

Köhler,

Soons

et al. 2023

Alzheimer's & Dementia

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A 2013 systematic review and Delphi consensus study identified 12 modifiable risk and protective factors for dementia, which were subsequently merged into the “LIfestyle for BRAin health” (LIBRA) score. We systematically evaluated whether LIBRA requires revision based on new evidence. To identify modifiable risk and protective factors suitable for dementia risk reduction, we combined an umbrella review of systematic reviews and meta‐analyses with a two‐round Delphi consensus study. The review of 608 unique primary studies and opinions of 18 experts prioritized six modifiable factors: hearing impairment, social contact, sleep, life course inequalities, atrial fibrillation, and psychological stress. Based on expert ranking, hearing impairment, social contact, and sleep were considered the most suitable candidates for inclusion in updated dementia risk scores. As such, the current study shows that dementia risk scores need systematic updates based on emerging evidence. Future studies will validate the updated LIBRA score in different cohorts.HIGHLIGHTS An umbrella review was combined with opinions of 18 dementia experts. Various candidate targets for dementia risk reduction were identified. Experts prioritized hearing impairment, social contact, and sleep. Re‐assessment of dementia risk scores is encouraged. Future work should evaluate the predictive validity of updated risk scores.

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The impact of maternal smoking during pregnancy and the age of smoking initiation on incident dementia: A prospective cohort study

Liu,

Xiao,

Zheng

et al. 2024

Alzheimer's & Dementia

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INTRODUCTIONThe impact of early‐life tobacco exposure on dementia has remained unknown.METHODSUsing the UK Biobank, the associations of maternal smoking during pregnancy (MSDP) and age of smoking initiation (ASI) with the onset time of all‐cause dementia were estimated with accelerated failure time models. The effects of MSDP and ASI on brain structure and their genetic correlation to Alzheimer's disease (AD) were analyzed. A Mendelian randomization (MR) analysis was conducted.RESULTSThe time ratios for smokers starting in childhood, adolescence, and adulthood (vs never smokers) were 0.87 (0.76 to 0.99), 0.92 (0.88 to 0.96), and 0.95 (0.89 to 1.01). MSDP and smoking in adolescence altered many brain regions, including the hippocampus. In genetic analysis, MSDP was genetically and causally linked to AD, and a younger ASI was genetically correlated to a higher AD risk.DISCUSSIONEarly‐life smoking accelerated dementia onset and was genetically correlated to AD. MSDP demonstrated genetic and causal linkage to AD risks.Highlights Unlike the commonly used Cox proportional hazards model, this article uses a parametric survival analysis method – the accelerated failure model – to explore the relationship between exposure to onset time. It can be used as an alternative method when the proportional hazards assumption is not met. Genetic analyses including genetic correlation study and MR analysis and brain structure analyses were conducted to support our findings and explore the potential mechanisms. The study reveals the relationship between different smoking initiation periods and the onset time of dementia and shows that earlier smoking exposure has a more significant impact on dementia. It emphasizes the importance of preventing early smoking. In the future, more research focusing on the relationship between early exposure and dementia is called for to provide more detailed prevention measures for dementia that cover all age groups.

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Socioeconomic Deprivation, Genetic Risk, and Incident Dementia

Cited by 13 publications

References 46 publications

Estimating the prevalence of diagnosed Alzheimer disease in England across deprivation groups using electronic health records: a clinical practice research datalink study

Estimating the prevalence of diagnosed Alzheimer disease in England across deprivation groups using electronic health records: a clinical practice research datalink study

Umbrella review and Delphi study on modifiable factors for dementia risk reduction

The impact of maternal smoking during pregnancy and the age of smoking initiation on incident dementia: A prospective cohort study

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