Li Joanne M, Boustani Malaz A, French Dustin D
Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Indiana University School of Medicine, Indianapolis, IN, USA.
Gerontol Geriatr Med. 2023 Aug 1;9:23337214231190244. doi: 10.1177/23337214231190244. eCollection 2023 Jan-Dec.
Alzheimer's Disease and related dementias affect 3.4 million community-dwelling adults in the United States. Given the burden of disease, a greater understanding of modifiable risk factors is crucial for targeted public health strategies. Social determinants of health (SDOH) are modifiable risk factors categorized in five domains: economic status, education, healthcare access, environment, and community context. Although individual SDOH have been linked to dementia, limited research exists on the interaction of SDOH with dementia across multiple domains. The aim of this study was to evaluate the association between SDOH across all five domains and dementia among community-dwelling adults in the United States. A cross-sectional study was performed on community-dwelling adults aged ≥65 years from the 2019 National Health Interview Survey (NHIS). Respondents ( = 9,277), of whom 303 (4%) self-reported positive dementia diagnosis, were predominantly female (55%), white (76%), and non-Hispanic (91%). Residing in a non-metropolitan area, having a usual place for healthcare, and receiving annual eye or dental exams were negatively associated with dementia. Minority compared to white status was not significantly associated with dementia, suggesting underdiagnosis of dementia within minority groups in the NHIS. We present the first comprehensive national view of SDOH among community-dwelling dementia patients in the United States.
在美国,阿尔茨海默病及相关痴呆症影响着340万居住在社区的成年人。鉴于疾病负担,深入了解可改变的风险因素对于有针对性的公共卫生策略至关重要。健康的社会决定因素(SDOH)是分为五个领域的可改变风险因素:经济状况、教育、医疗保健可及性、环境和社区背景。虽然个体SDOH已与痴呆症相关联,但关于SDOH在多个领域与痴呆症相互作用的研究有限。本研究的目的是评估美国居住在社区的成年人中所有五个领域的SDOH与痴呆症之间的关联。对来自2019年国家健康访谈调查(NHIS)的年龄≥6岁的居住在社区的成年人进行了一项横断面研究。受访者(n = 9277)中,303人(4%)自我报告痴呆症诊断呈阳性,主要为女性(55%)、白人(76%)和非西班牙裔(91%)。居住在非都市地区、有固定的医疗保健场所、接受年度眼科或牙科检查与痴呆症呈负相关。与白人相比,少数族裔身份与痴呆症无显著关联,这表明NHIS中少数群体的痴呆症诊断不足。我们展示了美国居住在社区的痴呆症患者中SDOH的首个全面的全国性情况。