Majoka Muniza Anum, Schimming Corbett
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; James J. Peters Veterans Affairs Medical Center, Bronx, New York.
Clin Ther. 2021 Jun;43(6):922-929. doi: 10.1016/j.clinthera.2021.05.005. Epub 2021 Jun 5.
Social determinants of health are the conditions in which people are born, work, live, and age and the wider set of forces and systems that shape the conditions of daily life. They affect every area of life, particularly health and health care. There is increasing focus on modifiable factors that affect cognition and risk of Alzheimer disease and related dementias (ADRDs). This article examines the impact of various social determinants of health, which are potentially reversible, on the incidence, prevalence, and risk of ADRDs and cognition. Various social determinants of health affect cognition and risk of ADRDs. Lower socioeconomic status (SES) and less education are associated with a higher incidence of ADRDs, whereas higher SES and education level appear to be protective, leading to a deceleration of time to diagnosis. In terms of employment, manual labor is associated with a higher risk of ADRDs. Higher body mass index in midlife and a decreasing body mass index in old age are associated with a higher risk of ADRDs. Furthermore, lower food security in early and late life is associated with a higher risk of ADRD diagnosis. Neighborhoods that are economically disadvantaged with fewer physical resources are associated with a higher risk of ADRDs. Higher levels of social engagement have a protective effect on diagnosis of ADRDs. Higher levels of stress are associated with a higher likelihood of developing ADRDs. Early-life adversity is associated with an increased risk of ADRDs, and further work in this area will be illuminating. Racial discrimination also leads to higher risk of ADRDs through the direct effect of discrimination and indirectly through lower SES, educational level, employment, and residential segregation. With an aim of reducing of ADRDs, future work in enhancing education, improving socioeconomic conditions, work, and neighborhood environments, and eliminating racial discrimination could potentially have a drastic impact.
健康的社会决定因素是人们出生、工作、生活和变老的环境，以及塑造日常生活条件的更广泛的力量和系统。它们影响生活的各个领域，尤其是健康和医疗保健。人们越来越关注影响认知以及患阿尔茨海默病和相关痴呆症（ADRDs）风险的可改变因素。本文探讨了各种可能可逆的健康社会决定因素对ADRDs的发病率、患病率和风险以及认知的影响。各种健康社会决定因素会影响ADRDs的认知和风险。社会经济地位（SES）较低和受教育程度较低与ADRDs的较高发病率相关，而较高的SES和教育水平似乎具有保护作用，可导致诊断时间延迟。在就业方面，体力劳动与患ADRDs的较高风险相关。中年时较高的体重指数和老年时体重指数下降与患ADRDs的较高风险相关。此外，生命早期和晚期较低的粮食安全与ADRDs诊断的较高风险相关。经济上处于不利地位且物质资源较少的社区与患ADRDs的较高风险相关。较高水平的社会参与对ADRDs的诊断具有保护作用。较高水平的压力与患ADRDs的可能性较高相关。生命早期的逆境与患ADRDs的风险增加相关，该领域的进一步研究将具有启发性。种族歧视还通过歧视的直接影响以及间接通过较低的SES、教育水平、就业和居住隔离导致患ADRDs的风险更高。为了减少ADRDs，未来在加强教育、改善社会经济状况、工作和社区环境以及消除种族歧视方面的工作可能会产生巨大影响。
