University of São Paulo, Faculty of Medicine, Institute of Psychiatry and LIM-23, São Paulo, Brazil.
Int Psychogeriatr. 2010 Dec;22(8):1209-15. doi: 10.1017/S1041610210001213. Epub 2010 Aug 3.
Dementia is now a major public health issue in low- and middle-income countries, and strategies for primary prevention are needed. This study aimed to estimate the proportion of cases of dementia attributable to illiteracy, non-skilled occupation and low income, which are common, potentially modifiable social adversities that occur along the lifespan in low- and middle-income countries.
This report is based on data from the São Paulo Ageing & Health Study (SPAH) study (N = 2003). All individuals aged 65 years and older residing within pre-defined socially deprived areas of the city of São Paulo, Brazil, were included. The outcome of interest was prevalent dementia. Indicators of socioeconomic position (SEP) were literacy (distal indicator), highest occupational attainment (intermediate indicator), and monthly personal income (proximal indicator). We estimated the proportion of prevalent dementia attributable to each SEP indicator (illiteracy, non-skilled occupations and low income) by calculating their population attributable fractions (PAF).
Dementia was more prevalent amongst participants who were illiterate, had non-skilled occupations and lower income. Illiteracy, poor occupational achievement and low income accounted for 22.0%, 38.5% and 38.5% of the cases of dementia, respectively. There was a cumulative effect of socioeconomic adversities during the lifespan, and nearly 50% of the prevalence of dementia could be potentially attributed to the combination of two or three of the socioeconomic adversities investigated.
Public policies aimed at improving education, occupational skills and income could potentially have a role in primary prevention of dementia. Governments should address this issue in a purposeful and systematic way.
痴呆症现在是中低收入国家的一个主要公共卫生问题，需要制定初级预防策略。本研究旨在估计痴呆症病例归因于文盲、非熟练职业和低收入的比例，这些是中低收入国家一生中常见的、潜在可改变的社会逆境。
本报告基于来自圣保罗老龄化与健康研究（SPAH 研究）（N=2003）的数据。所有年龄在 65 岁及以上、居住在巴西圣保罗市预先划定的社会贫困地区的人都包括在内。感兴趣的结果是普遍存在的痴呆症。社会经济地位（SEP）指标包括识字（远端指标）、最高职业成就（中间指标）和每月个人收入（近端指标）。我们通过计算其人群归因分数（PAF），估计每个 SEP 指标（文盲、非熟练职业和低收入）导致的普遍存在的痴呆症的比例。
文盲、非熟练职业和低收入的参与者中痴呆症更为普遍。文盲、较差的职业成就和低收入分别导致 22.0%、38.5%和 38.5%的痴呆症病例。在整个生命周期中存在社会经济逆境的累积效应，将近 50%的痴呆症患病率可能归因于所调查的两种或三种社会经济逆境的组合。
旨在提高教育、职业技能和收入的公共政策可能在痴呆症的初级预防中发挥作用。政府应有针对性和系统地解决这一问题。
