Alhasan Dana M, Lohman Matthew C, Hirsch Jana A, Miller Maggi C, Cai Bo, Jackson Chandra L
Epidemiology Branch, Department of Health and Human Services, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, United States.
Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.
Front Aging Neurosci. 2022 Sep 20;14:937915. doi: 10.3389/fnagi.2022.937915. eCollection 2022.
Neuropsychiatric symptoms (NPSs) lead to myriad poor health outcomes among individuals with Alzheimer's disease (AD). Prior studies have observed associations between the various aspects of the home environment and NPSs, but macro-level environmental stressors (e.g., neighborhood income) may also disrupt the neuronal microenvironment and exacerbate NPSs. Yet, to our knowledge, no studies have investigated the relationship between the neighborhood environment and NPSs.
Using 2010 data among older adults with AD collected from a sample of the South Carolina Alzheimer's Disease Registry, we estimated cross-sectional associations between neighborhood characteristics and NPSs in the overall population and by race/ethnicity. Neighborhood measures (within a 1/2-mile radius of residence) came from the American Community Survey and Rural Urban Commuting Area Code. We categorized median household income into tertiles: < $30,500, $30,500-40,000, and > $40,000, and rurality as: rural, small urban, and large urban. Residential instability was defined as the percent of residents who moved within the past year. NPSs were defined using the Neuropsychiatric Inventory Questionnaire that included the composite measure of all 12 domains. Adjusting for age, sex/gender, race/ethnicity, and caregiver educational attainment, we used negative binomial regression to estimate prevalence ratios (PR) and 95% confidence intervals (CI) for NPSs by neighborhood characteristics.
Among 212 eligible participants, mean age was 82 ± 8.7 years, 72% were women, and 55% non-Hispanic (NH)-Black. Individuals with AD living in < $30,500 vs. > $40,000 income neighborhoods had a 53% (PR = 1.53; 95% CI = 1.06-2.23) higher prevalence of NPSs while individuals living in rural vs. large urban neighborhoods had a 36% lower prevalence of NPSs (PR = 0.64; 95% CI = 0.45-0.90), after adjustment. We did not observe an association between residential instability and NPSs (PR = 0.92; 95% CI = 0.86-1.00); however, our estimates suggested differences by race/ethnicity where NH-White older adults living in residential instable areas had lower NPSs (PR = 0.89; 95% CI = 0.82-0.96) compared to NH-Black older adults (PR = 0.96; 95% CI = 0.86-1.07).
Across racial/ethnic groups, individuals with AD had more symptomology when living in lower income areas. Pending replication, intervention efforts should consider resource allocation to high-need neighborhoods (e.g., lower income), and studies should investigate underlying mechanisms for this relationship.
神经精神症状（NPSs）在阿尔茨海默病（AD）患者中会导致无数不良健康后果。先前的研究已经观察到家庭环境的各个方面与NPSs之间的关联，但宏观层面的环境压力源（如邻里收入）也可能扰乱神经元微环境并加剧NPSs。然而，据我们所知，尚无研究调查邻里环境与NPSs之间的关系。
利用从南卡罗来纳州阿尔茨海默病登记处样本中收集的2010年老年AD患者数据，我们估计了总体人群以及按种族/民族划分的邻里特征与NPSs之间的横断面关联。邻里指标（居住半径半英里范围内）来自美国社区调查和城乡通勤区代码。我们将家庭收入中位数分为三个三分位数：<$30,500、$30,500 - 40,000和>$40,000，并将农村地区分为：农村、小城市和大城市。居住不稳定性定义为过去一年中搬家的居民百分比。NPSs使用神经精神问卷进行定义，该问卷包括所有12个领域的综合测量。在调整年龄、性别、种族/民族和照顾者教育程度后，我们使用负二项回归来估计按邻里特征划分的NPSs的患病率比值（PR）和95%置信区间（CI）。
在212名符合条件的参与者中，平均年龄为82±8.7岁，72%为女性，55%为非西班牙裔（NH）黑人。与收入>$40,000的社区相比，生活在收入<$30,500社区的AD患者NPSs患病率高53%（PR = 1.
