Cross‐sectional association between the area deprivation index (ADI) and cognitive impairment in community‐dwelling older veterans

Abstract

AbstractBackgroundThe evidence that lower socio‐economic status (SES) may be associated with late‐onset dementia is inconsistent. Differences may be related to how SES was assessed. The area deprivation index (ADI) is a validated, composite measure of neighborhood socioeconomic status representing a geographic area level of social deprivation. Previous research has shown an association between ADI and cognitive impairment, but less is known about the Veteran population. The study aim was to determine the cross‐sectional association between the area deprivation index (ADI) and cognitive impairment in a Veteran population.MethodThis is a cross‐sectional study among community‐dwelling Veterans aged ≥50 years enrolled in a VA primary care clinic from July 2019‐May 2020. Patients were mailed questionnaires including sociodemographic, the Self‐Administered Gerocognitive Examination (SAGE). Clinical information was extracted from the electronic health records (EHR). To assess frailty, we used a 31‐item VA Frailty Index (VA‐FI) generated from EHR data matched to the study date. We calculated the ADI from 17 socioeconomic indicators available from the US Census. ADIs were generated for census tracts corresponding to veterans’ addresses. Higher ADI values are consistent with increased deprivation. After adjusting for age, gender, marital status, race, ethnicity, body mass index and frailty, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using binomial logistic regression models with cognitive impairment (MCI and dementia) as the outcome variable and ADI as the independent variable.ResultParticipants were 1060 Veterans (response rate of 20.14%), mean age of 68.39 (SD=8.52) years, 59.0% Caucasian, 69.2% non‐Hispanic, 95.8% male, 12.0% screened positive for MCI and 15.6% for dementia. Among ADI quintile groups, patients in the highest group had a significantly higher proportion of cognitive impairment (40.59%) when compared to lower groups, p<.001. No significant differences were found between quintiles 1 to 4. The highest ADI quintile was the only group associated with cognitive impairment, adjusted OR: 1.916 (95% CI:1.187‐3.093), p=.008.ConclusionThis study shows a cross‐sectional association between ADI and dementia in community‐dwelling older Veterans. Further investigation of the links between neighborhood social deprivation and cognitive impairment may assist in the development of strategies that lower the incidence of cognitive impairment in these communities.