The Social Vulnerability Index and Incidence of Alzheimer Disease in a Population-Based Sample of Older Adults.

IF 7.7 1区医学 Q1 CLINICAL NEUROLOGY

Neurology Pub Date : 2025-04-22 Epub Date: 2025-03-26 DOI:10.1212/WNL.0000000000213464

Pankaja Desai, Jerenda Bond, Anisa Dhana, Ted K S Ng, Kristin R Krueger, Klodian Dhana, Xiaoran Liu, Denis A Evans, Kumar B Rajan

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Abstract

Background and objectives: The primary study objective was to examine the association between Social Vulnerability index (SVI) and risk of incident Alzheimer disease (AD) and rate of cognitive decline.

Methods: This is a secondary analysis of data from the Chicago Health and Aging Project, a population-based cohort study. Participants were recruited through door visits, were at least 65 years of age at enrollment, and lived in one of 4 Chicago communities representing 24 US census tracts. The association of SVI with clinically diagnosed incident AD was examined using a logistic regression model and global cognitive decline using a linear mixed-effects model.

Results: A total of 6,781 participants were in this study, with a mean age of 72 years, representing over 60% Black participants and over 60% female participants, and with a mean of 12 years of education. Over 90% of Black participants were in tracts above 50% or higher SVI, and approximately 87% of White participants were in tracts with SVI 50% or less. Participants in tracts with SVI above 50th to 75th percentiles had OR = 2.23 (95% CI 1.23-4.05) for clinical AD, and participants in tracts greater than the 75th percentile had OR = 2.04 (95% CI 1.03-4.04). Participants in more vulnerable tracts had greater incident AD risk than participants in less vulnerable tracts. The annual rate of global cognitive decline was 0.055 SD units (SDU) for participants below the 25th SVI percentile. The annual rate of global cognitive decline was faster by 0.010 SDU (approximately 18% faster, p = 0.025) in those above the 50th-75th percentile and by 0.014 SDU (approximately 25% faster, p = 0.005) in participants above the 75th percentile than in participants below the 25th SVI percentile.

Discussion: Most Black participants who lived in areas with higher SVI that had over twice the risk of incident AD than most White participants who lived in areas with lower SVI, showing a higher social burden in Black older adults. There was no statistically significant race difference in incident AD after adjusting for SVI. SVI should be accounted for when examining race differences in AD.

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老年人社会脆弱性指数和阿尔茨海默病发病率

背景与目的研究的主要目的是探讨社会脆弱性指数（SVI）与阿尔茨海默病（AD）发病风险和认知能力下降率之间的关系：这是对芝加哥健康与老龄化项目数据的二次分析，该项目是一项基于人群的队列研究。参与者是通过上门访问招募的，入选时年龄至少为 65 岁，居住在代表美国 24 个人口普查区的芝加哥 4 个社区之一。采用逻辑回归模型研究了SVI与临床诊断的AD发病率的关系，采用线性混合效应模型研究了全球认知能力下降的关系：本研究共有 6781 名参与者，平均年龄为 72 岁，60% 以上为黑人，60% 以上为女性，平均受教育年限为 12 年。超过 90% 的黑人参与者居住在 SVI 值 50% 或以上的地区，约 87% 的白人参与者居住在 SVI 值 50% 或以下的地区。在 SVI 值高于第 50 到 75 百分位数的地区，参与者的临床 AD OR = 2.23（95% CI 1.23-4.05），而在 SVI 值高于第 75 百分位数的地区，参与者的临床 AD OR = 2.04（95% CI 1.03-4.04）。与较脆弱地区的参与者相比，较脆弱地区的参与者具有更高的AD发病风险。在 SVI 百分位数第 25 位以下的参与者中，总体认知能力的年下降率为 0.055 SDU。与SVI第25百分位数以下的参与者相比，高于第50-75百分位数的参与者的整体认知能力下降年率快0.010 SDU（约快18%，p = 0.025），高于第75百分位数的参与者的整体认知能力下降年率快0.014 SDU（约快25%，p = 0.005）：大多数居住在 SVI 值较高地区的黑人参与者比大多数居住在 SVI 值较低地区的白人参与者发生注意力缺失症的风险高出一倍以上，这表明黑人老年人的社会负担较重。在调整 SVI 后，发生注意力缺失症的种族差异没有统计学意义。在研究注意力缺失症的种族差异时，应将SVI考虑在内。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurology 医学-临床神经学

CiteScore

12.20

自引率

4.00%

发文量

1973

审稿时长

2-3 weeks

期刊介绍： Neurology, the official journal of the American Academy of Neurology, aspires to be the premier peer-reviewed journal for clinical neurology research. Its mission is to publish exceptional peer-reviewed original research articles, editorials, and reviews to improve patient care, education, clinical research, and professionalism in neurology. As the leading clinical neurology journal worldwide, Neurology targets physicians specializing in nervous system diseases and conditions. It aims to advance the field by presenting new basic and clinical research that influences neurological practice. The journal is a leading source of cutting-edge, peer-reviewed information for the neurology community worldwide. Editorial content includes Research, Clinical/Scientific Notes, Views, Historical Neurology, NeuroImages, Humanities, Letters, and position papers from the American Academy of Neurology. The online version is considered the definitive version, encompassing all available content. Neurology is indexed in prestigious databases such as MEDLINE/PubMed, Embase, Scopus, Biological Abstracts®, PsycINFO®, Current Contents®, Web of Science®, CrossRef, and Google Scholar.