Research Group Psychosocial Epidemiology and Public Health, German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Ellernholzstr 1-2, 17489 Greifswald, Germany.
Epidemiol Psychiatr Sci. 2023 Feb 14;32:e10. doi: 10.1017/S2045796023000033.
Knowledge on the link of individual social deprivation with dementia is incomplete. We thus aimed to see whether an association with dementia risk can be observed using a recently developed Social Deprivation Index (SoDep Index). Further, as deprivation is related to depression, we investigated the role of depression in the association.
We analysed data of 11 623 Survey of Health, Ageing and Retirement in Europe (SHARE) respondents. Social deprivation status was determined by SoDep Index score. Dementia was determined by self-reported diagnosis. Dementia risk by social deprivation status was estimated using Cox proportional hazard models, including relevant covariates (gender, marriage status, chronic conditions). Depressive symptom status was added in a second step. Further, we completed subgroup analyses by social deprivation status and analysed the relevance of depressive symptoms in dementia risk in each deprivation group. In an additional sensitivity analyses we corrected for mortality and used impaired cognitive testing performance as an alternative outcome.
High (. low) social deprivation status was associated with an increased dementia risk (hazard ratio (HR) = 1.79 [95% CI 1.31-2.45]) in the Cox analysis adjusted for covariates only. Further adjustment for depressive symptom status indicated a largely direct association between social deprivation status and dementia risk. Moreover, compared to not having experienced depressive symptoms in the past or at baseline, those with past (HR = 1.67 [95% CI 1.23-2.25]), baseline (HR = 1.48 [95% CI 1.04-2.10]) or stable depressive symptoms (HR = 2.96 [95% CI 2.12-4.14]) had an increased dementia risk. The association between stable depressive symptom status and dementia risk was in the high social deprivation subgroup particularly pronounced. Sensitivity analyses replicated results.
Results add to a growing body of evidence indicating that a public health approach to dementia prevention must address socioeconomic inequity. Results suggest a largely direct association between social deprivation and dementia risk. Adults who experience high social deprivation appear particularly affected by detrimental effects of depressive symptomatology on dementia risk and need intervention.
个体社会剥夺与痴呆之间的关联尚不完全清楚。因此，我们旨在使用最近开发的社会剥夺指数（SoDep 指数）观察是否可以观察到与痴呆风险的关联。此外，由于剥夺与抑郁有关，我们研究了抑郁在关联中的作用。
我们分析了欧洲健康、老龄化和退休调查（SHARE）11623 名受访者的数据。社会剥夺状况由 SoDep 指数得分决定。痴呆由自我报告的诊断确定。使用 Cox 比例风险模型估计社会剥夺状况与痴呆风险之间的关系，包括相关协变量（性别、婚姻状况、慢性疾病）。在第二步中添加抑郁症状状况。此外，我们按社会剥夺状况进行亚组分析，并分析每个剥夺组中抑郁症状在痴呆风险中的相关性。在额外的敏感性分析中，我们校正了死亡率，并将认知测试表现受损作为替代结局。
在仅调整协变量的 Cox 分析中，高（低）社会剥夺状况与痴呆风险增加相关（风险比（HR）=1.79[95%CI 1.31-2.45]）。进一步调整抑郁症状状况表明，社会剥夺状况与痴呆风险之间存在直接关联。此外，与过去或基线时没有经历过抑郁症状的人相比，过去（HR=1.67[95%CI 1.23-2.25]）、基线（HR=1.48[95%CI 1.04-2.10]）或稳定抑郁症状（HR=2.96[95%CI 2.12-4.14]）的人痴呆风险增加。稳定抑郁症状状况与痴呆风险之间的关联在高社会剥夺亚组中尤为明显。敏感性分析复制了结果。
研究结果进一步证明，预防痴呆的公共卫生方法必须解决社会经济不平等问题。结果表明，社会剥夺与痴呆风险之间存在直接关联。经历高社会剥夺的成年人似乎特别受到抑郁症状对痴呆风险的不利影响的影响，需要干预。
