Institute for Research on Socio-Economic Inequality, Department of Social Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg; The Deep Dementia Phenotyping Network, Exeter, United Kingdom.
Institute for Research on Socio-Economic Inequality, Department of Social Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg; The Deep Dementia Phenotyping Network, Exeter, United Kingdom.
Am J Prev Med. 2023 May;64(5):621-630. doi: 10.1016/j.amepre.2023.01.012. Epub 2023 Mar 6.
Socioeconomic factors and genetic predisposition are established risk factors for dementia. It remains unclear whether associations of socioeconomic deprivation with dementia incidence are modified by genetic risk.
Participants in the UK Biobank aged ≥60 years and of European ancestry without dementia at baseline (2006-2010) were eligible for the analysis, with the main exposures area-level deprivation based on the Townsend Deprivation Index and individual-level socioeconomic deprivation based on car and home ownership, housing type and income, and polygenic risk of dementia. Dementia was ascertained in hospital and death records. Analysis was conducted in 2021.
In this cohort study, 196,368 participants (mean [SD] age=64.1 [2.9] years, 52.7% female) were followed up for 1,545,316 person-years (median [IQR] follow-up=8.0 [7.4-8.6] years). In high genetic risk and high area-level deprivation, 1.71% (95% CI=1.44, 2.01) developed dementia compared with 0.56% (95% CI=0.48, 0.65) in low genetic risk and low-to-moderate area-level deprivation (hazard ratio=2.31; 95% CI=1.84, 2.91). In high genetic risk and high individual-level deprivation, 1.78% (95% CI=1.50, 2.09) developed dementia compared with 0.31% (95% CI=0.20, 0.45) in low genetic risk and low individual-level deprivation (hazard ratio=4.06; 95% CI=2.63, 6.26). There was no significant interaction between genetic risk and area-level (p=0.77) or individual-level (p=0.07) deprivation. An imaging substudy including 11,083 participants found a greater burden of white matter hyperintensities associated with higher socioeconomic deprivation.
Individual-level and area-level socioeconomic deprivation were associated with increased dementia risk. Dementia prevention interventions may be particularly effective if targeted to households and areas with fewer socioeconomic resources, regardless of genetic vulnerability.
社会经济因素和遗传易感性是痴呆的既定风险因素。目前尚不清楚社会经济剥夺与痴呆发病率之间的关联是否受遗传风险的影响。
本分析纳入了英国生物库中年龄≥60 岁且基线时（2006-2010 年）无痴呆的欧洲血统参与者，主要暴露因素为基于汤森剥夺指数的地区水平剥夺和基于汽车和住房所有权、住房类型和收入以及痴呆多基因风险的个体水平社会经济剥夺。痴呆通过医院和死亡记录确定。分析于 2021 年进行。
在这项队列研究中，196368 名参与者（平均[标准差]年龄=64.1[2.9]岁，52.7%为女性）随访 1545316 人年（中位数[IQR]随访=8.0[7.4-8.6]年）。在高遗传风险和高地区水平剥夺的情况下，1.71%（95%CI=1.44，2.01）发生痴呆，而低遗传风险和低-中度地区水平剥夺的情况下为 0.56%（95%CI=0.48，0.65）（风险比=2.31；95%CI=1.84，2.91）。在高遗传风险和高个体水平剥夺的情况下，1.78%（95%CI=1.50，2.09）发生痴呆，而低遗传风险和低个体水平剥夺的情况下为 0.31%（95%CI=0.20，0.45）（风险比=4.06；95%CI=2.63，6.26）。遗传风险与地区水平（p=0.77）或个体水平（p=0.07）剥夺之间无显著交互作用。包括 11083 名参与者的影像学子研究发现，与较高社会经济剥夺相关的白质高信号负担更大。
个体水平和地区水平的社会经济剥夺与痴呆风险增加相关。如果针对社会经济资源较少的家庭和地区进行痴呆预防干预，可能会特别有效，而不论遗传易感性如何。
