Sex Differences for Social Determinants Associated with Lewy Body Dementia Onset and Diagnosis.

Introduction: Multiple studies report sex and gender differences in Lewy body dementia (LBD); however, there is a paucity of research investigating social determinants associated with LBD.

Methods: Participants with LBD (51 females, 79 males) and controls with similar age (64 females, 60 males) completed remote surveys assessing various social and demographic variables, and age at LBD onset for LBD group. Sex-stratified comparisons for LBD and control groups, and comparisons of females and males with LBD were done for social determinants. Sex differences for onset age were further analyzed with linear models adjusting for significantly differing social variables between the sexes.

Results: LBD group had lower years of education, income, subjective social status than controls, with larger differences for males than females (p < 0.05 for all). Higher percentage of females with LBD was living alone (p = 0.016) and not married/partnered (p = 0.002) compared to males with LBD. Adjusting for social variables that differed between the sexes, females were younger at cognitive impairment onset (p = 0.037) and diagnosis (p = 0.032). For the overall cohort, being ethnoracial minoritized, sexual and gender minoritized, and having lower education quality were associated with younger age at symptom onset (p < 0.049 for all). For females, lower childhood subjective social status (p = 0.037), and for males, being ethnoracial minoritized (p < 0.001) and lower years of education (p = 0.031) were associated with younger age at diagnosis.

Conclusion: Social determinants, even during childhood, can impact the LBD onset differently for females and males. Interactions between biological and social factors need to be investigated further with inclusive and diverse cohorts in LBD.