Associations of socioeconomic status and healthy lifestyle with incident dementia and cognitive decline: two prospective cohort studies.

IF 9.6 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

EClinicalMedicine Pub Date : 2024-09-16 eCollection Date: 2024-10-01 DOI:10.1016/j.eclinm.2024.102831

Kan Wang, Yuan Fang, Ruizhi Zheng, Xuan Zhao, Siyu Wang, Jieli Lu, Weiqing Wang, Guang Ning, Yu Xu, Yufang Bi

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引用次数: 0

Abstract

Background: Little is known about the complex associations of socioeconomic status (SES) and healthy lifestyle with cognitive dysfunction.

Methods: Using data from the Health and Retirement Study (HRS) [2008-2020] and the English Longitudinal Study of Ageing (ELSA) [2004-2018], SES was constructed by latent class analysis using education level, total household income and wealth. Overall healthy lifestyle was derived using information on never smoking, low to moderate alcohol consumption (drinks/day: (0, 1] for women and (0, 2] for men), top tertile of physical activity, and active social contact.

Findings: A total of 12,437 and 6565 participants from the HRS and ELSA were included (40.8% and 46.0% men and mean age 69.3 years and 65.1 years, respectively). Compared with participants of high SES, those of low SES had higher risk of incident dementia (hazard ratio 3.17, 95% confidence interval 2.72-3.69 in the HRS; 1.43, 1.09-1.86 in the ELSA), and the proportions mediated by overall lifestyle were 10.4% (7.3%-14.6%) and 2.7% (0.5%-14.0%), respectively. Compared with participants of high SES and favorable lifestyle, those with low SES and unfavorable lifestyle had a higher risk of incident dementia (4.27, 3.40-5.38 in the HRS; 2.02, 1.25-3.27 in the ELSA) and accelerated rate of global cognitive decline (β = -0.058 SD/year; 95% CI: -0.073, -0.043 in the HRS; β = -0.049 SD/year; 95% CI: -0.063, -0.035 in the ELSA).

Interpretation: Unhealthy lifestyle only mediated a small proportion of the socioeconomic inequality in dementia risk in both US and UK older adults.

Funding: This work was supported by grants from the National Natural Science Foundation of China (82088102 and 82370819), the National Key R&D Program of China (2023YFC2506700), the Shanghai Municipal Government (22Y31900300), the Shanghai Clinical Research Center for Metabolic Diseases (19MC1910100), the Innovative Research Team of High-Level Local Universities in Shanghai, the Special Project for Clinical Research in Health Industry of Shanghai Municipal Health Commission (202340084), and Ruijin Hospital Youth Incubation Project (KY20240805). Y.X. is supported by the National Top Young Talents program.

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社会经济地位和健康生活方式与痴呆症和认知能力下降的关系：两项前瞻性队列研究。

背景人们对社会经济地位（SES）和健康生活方式与认知功能障碍之间的复杂关系知之甚少：利用健康与退休研究（HRS）[2008-2020]和英国老龄化纵向研究（ELSA）[2004-2018]的数据，通过潜类分析法利用教育水平、家庭总收入和财富构建社会经济地位。总体健康生活方式是通过从不吸烟、中低度饮酒量（饮酒量/天：女性为（0，1），男性为（0，2））、体力活动最高三分位数和积极的社会接触等信息得出的：共有 12,437 人和 6565 人参加了 HRS 和 ELSA（男性分别占 40.8% 和 46.0%，平均年龄分别为 69.3 岁和 65.1 岁）。与社会经济地位高的参与者相比，社会经济地位低的参与者患痴呆症的风险更高（HRS 的危险比为 3.17，95% 置信区间为 2.72-3.69；ELSA 的危险比为 1.43，1.09-1.86），受整体生活方式影响的比例分别为 10.4% (7.3%-14.6%)和 2.7% (0.5%-14.0%)。与社会经济地位高且生活方式良好的参与者相比，社会经济地位低且生活方式不良的参与者发生痴呆症的风险更高（在 HRS 中为 4.27，3.40-5.38；在 ELSA 中为 2.02，1.25-3.27），并且痴呆症的发病速度更快。在ELSA中为2.02，1.25-3.27），整体认知能力下降速度加快（β=-0.058 SD/年；在HRS中为95% CI：-0.073，-0.043；在ELSA中为β=-0.049 SD/年；在HRS中为95% CI：-0.063，-0.035）：不健康的生活方式只调节了美国和英国老年人痴呆症风险中社会经济不平等的一小部分：本研究得到了国家自然科学基金（82088102和82370819）、国家重点研发计划（2023YFC2506700）、上海市政府（22Y31900300）、上海市代谢性疾病临床研究中心（19MC1910100）、上海市地方高校高水平创新研究团队、上海市卫生健康委员会健康产业临床研究专项（202340084）和瑞金医院青年孵化项目（KY20240805）的资助。Y.X. 获国家 "青年拔尖人才 "项目资助。

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来源期刊

EClinicalMedicine Medicine-Medicine (all)

CiteScore

18.90

自引率

1.30%

发文量

506

审稿时长

22 days

期刊介绍： eClinicalMedicine is a gold open-access clinical journal designed to support frontline health professionals in addressing the complex and rapid health transitions affecting societies globally. The journal aims to assist practitioners in overcoming healthcare challenges across diverse communities, spanning diagnosis, treatment, prevention, and health promotion. Integrating disciplines from various specialties and life stages, it seeks to enhance health systems as fundamental institutions within societies. With a forward-thinking approach, eClinicalMedicine aims to redefine the future of healthcare.