Social Environment, Lifestyle, and Genetic Predisposition With Dementia Risk: A Long-Term Longitudinal Study Among Older Adults

Author:

Chen Shu12ORCID,Chen Shanquan3ORCID,Hanewald Katja12ORCID,Si Yafei12ORCID,Bateman Hazel12ORCID,Li Bingqin4ORCID,Xu Xiaolin56ORCID,Samtani Suraj7ORCID,Wu Chenkai8ORCID,Brodaty Henry7ORCID

Affiliation:

1. School of Risk and Actuarial Studies, UNSW Business School, UNSW Sydney , Sydney, New South Wales , Australia

2. Australian Research Council Centre of Excellence in Population Ageing Research (CEPAR) , Kensington, New South Wales , Australia

3. International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine , London , UK

4. Social Policy Research Centre, UNSW Sydney , Sydney, New South Wales , Australia

5. School of Public Health, Zhejiang University Department of Big Data in Health Science, , Hangzhou, Zhejiang , China

6. Centre of Clinical Big Data and Analytics, The Second Affiliated Hospital Zhejiang University School of Medicine , Hangzhou, Zhejiang , China

7. Centre for Healthy Brain Ageing (CHeBA), School of Clinical Medicine, Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, UNSW Sydney , Sydney, New South Wales , Australia

8. Global Health Research Center, Duke Kunshan University , Kunshan, Jiangsu , China

Abstract

Abstract Background The role of social environment, that is, the aggregate effect of social determinants of health (SDOHs), in determining dementia is unclear. Methods We developed a novel polysocial risk score for dementia based on 19 SDOH among 5 199 participants in the Health and Retirement Study, United States, to measure the social environmental risk. We used a survival analysis approach to assess the association between social environment and dementia risk in 2006–2020. We further studied the interaction between social environment and lifestyles, and explored racial disparities. Results The study participants (mean age = 73.4 years, SD = 8.3; 58.0% female; 11.6% African American) were followed up for an average of 6.2 years, and 1 089 participants developed dementia. Every 1-point increase in the polysocial risk score (ranging from 0 to 10) was associated with a 21.6% higher risk (adjusted hazard ratio [aHR] = 1.21, 95% confidence intervals [95% CI] = 1.15–1.26) of developing dementia, other things being equal. Among participants with high social environmental risk, regular exercise and moderate drinking were associated with a 43%–60% lower risk of developing dementia (p < .001). In addition, African Americans were 1.3 times (aHR = 2.28, 95% CI = 1.96–2.66) more likely to develop dementia than European Americans, other things being equal. Conclusion An adverse social environment is linked to higher dementia risk, but healthy lifestyles can partially offset the increased social environmental risk. The polysocial risk score can complement the existing risk tools to identify high-risk older populations, and guide the design of targeted social environmental interventions, particularly focusing on improving the companionship of the older people, to prevent dementia.

Funder

University of New South Wales

ARC Centre of Excellence in Population Ageing Research

UK Foreign, Commonwealth and Development Office

National Institute on Aging

Publisher

Oxford University Press (OUP)

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