Ganguli Mary, Jacobsen Erin, Song Ruopu, Wood Isabella, Kinnee Ellen J, Hughes Tiffany F, Snitz Beth E, Chang Chung-Chou H
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
J Am Geriatr Soc. 2025 Feb;73(2):367-378. doi: 10.1111/jgs.19251. Epub 2024 Nov 20.
The associations between community-wide social determinants of health and mild cognitive impairment (MCI) among individuals warrant investigation.
Among 2830 dementia-free individuals aged 65+ years in a community-based US study, we examined cross-sectional associations of MCI (Clinical Dementia Rating = 0.5) with the following potential social determinants of health: at the census tract or block group level obtained from public sources: neighborhood disadvantage (Area Deprivation Index, ADI), air pollution with fine particulate matter (PM), greenspace, Walkability Index, ambulatory healthcare availability per square mile, homicide rate; and at the individual participant level, birth/schooling in a southern US state.
Unadjusted logistic regression models found higher odds ratios (OR, 95% CI) for MCI with higher ADI (1.01, 1.003-1.02), higher PM (1.16, 1.07-1.26), higher homicide rate (1.007, 1.001-1.012), lesser greenspace (0.99, 0.90-0.99), and southern schooling (2.06, 1.6-3.54). Adjusting for age, race, sex, and educational level, ADI remained statistically significant (1.04, 1.01-1.06), while PM and Southern state schooling interacted significantly with race and were more strongly affected in Black participants than in White participants.
In this cohort, several community-wide social/environmental factors were associated with MCI. While clinicians should continue to encourage older adults to modify their individual risk factors, policy changes are needed to mitigate social determinants of health in the community.
社区层面的健康社会决定因素与个体轻度认知障碍（MCI）之间的关联值得研究。
在美国一项基于社区的研究中，对2830名65岁及以上无痴呆症个体进行研究，我们考察了MCI（临床痴呆评定量表=0.5）与以下潜在健康社会决定因素之间的横断面关联：在从公共来源获取的普查区或街区组层面：邻里劣势（地区剥夺指数，ADI）、细颗粒物（PM）空气污染、绿地、步行适宜性指数、每平方英里的门诊医疗可及性、凶杀率；以及在个体参与者层面，在美国南部州出生/接受教育情况。
未调整的逻辑回归模型发现，MCI的优势比（OR，95%可信区间）在以下情况更高：较高的ADI（1.01，1.003 - 1.02）、较高的PM（1.16，1.07 - 1.26）、较高的凶杀率（1.007，1.001 - 1.012）、较少的绿地（0.99，0.90 - 0.99）以及在美国南部接受教育（2.06，1.6 - 3.54）。在调整年龄、种族、性别和教育水平后，ADI仍具有统计学显著性（1.04，1.01 - 1.06），而PM和在美国南部州接受教育与种族存在显著交互作用，并且在黑人参与者中比在白人参与者中受影响更强。
在这个队列中，几个社区层面的社会/环境因素与MCI相关。虽然临床医生应继续鼓励老年人改变其个体风险因素，但需要政策改变以减轻社区中的健康社会决定因素。
