Taylor Katherine, Marston Louise, Mukadam Naaheed
Division of Biosciences, Medical Sciences Building, University College London, Gower Street, London, WC1E 6BT, U.K..
Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF, U.K.
BMC Psychiatry. 2025 Feb 25;25(1):174. doi: 10.1186/s12888-025-06619-4.
Many studies observe a negative association between education and all-cause dementia, however, little is known about how the association develops. Current evidence regarding mediatory factors is limited, conflicted and suggests a complex relationship. In this study we used UK Biobank data to determine to what extent multiple factors mediate the association.
Data was sourced from UK Biobank and multiple imputation used to replace missing values. Education was measured at baseline assessment and dementia diagnosis determined from self-report or linked healthcare records. Five potential mediators were considered: Social isolation, income and occupational complexity were measured at baseline and health behaviour and health outcome scores derived. Logistic regression was used to examine the association between education and dementia with adjustment for potential mediators. Causal mediation analysis was then performed to determine the proportion of the dementia education association occurring via each mediatory pathway.
In a sample of 384,284 participants, higher level of education was associated with reduced odds of dementia. When considered as a confounder, occupational complexity almost fully attenuated the association (OR: 0.94, CI: 0.89-0.99) and was found to mediate 73% of the association. Average income, health outcomes and health behaviours also acted as mediators, explaining 10%, 27% and 35% of the relationship respectively.
Occupational complexity mediates a large proportion of the association between education and dementia. Intervention to improve access to cognitively stimulating work and leisure activities, particularly to those who are less educated, may reduce the number of people in the UK living with dementia.
许多研究观察到教育与全因性痴呆之间存在负相关，但对于这种关联如何发展却知之甚少。目前关于中介因素的证据有限且相互矛盾，提示存在复杂的关系。在本研究中，我们使用英国生物银行的数据来确定多种因素在多大程度上介导了这种关联。
数据来源于英国生物银行，采用多重填补法替代缺失值。在基线评估时测量教育程度，通过自我报告或关联的医疗记录确定痴呆诊断。考虑了五个潜在中介因素：在基线时测量社会隔离、收入和职业复杂性，并得出健康行为和健康结果得分。使用逻辑回归分析教育与痴呆之间的关联，并对潜在中介因素进行调整。然后进行因果中介分析，以确定通过每条中介途径发生的痴呆与教育关联的比例。
在384,284名参与者的样本中，较高的教育水平与痴呆几率降低相关。当将职业复杂性视为混杂因素时，几乎完全减弱了这种关联（OR：0.94，CI：0.89 - 0.99），并发现其介导了73%的关联。平均收入、健康结果和健康行为也起到了中介作用，分别解释了这种关系的10%、27%和35%。
职业复杂性介导了教育与痴呆之间很大比例的关联。采取干预措施以改善获得认知刺激工作和休闲活动的机会，特别是对于受教育程度较低的人群，可能会减少英国痴呆症患者的数量。
