Identifying Key Patterns of Social and Structural Determinants of Health and Their Association with Dementia Risk in a Population-Based Study of Cognitive Aging (P1-12.007)

Abstract

<h3>Objective:</h3> To examine patterns of social and structural determinants of health (SSDoH) and their association with dementia risk in Mayo Clinic Study of Aging participants. <h3>Background:</h3> Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD) risk, diagnosis, and disease prognosis are associated with SSDoH, but have not been studied with similar rigor as biological or behavioral risk factors. <h3>Design/Methods:</h3> We identified 2,880 participants (mean age (SD): 68.8 (9.7); 50.2% female) with complete SSDoH data at baseline. Using the recently proposed multidimensional SSDoH framework for AD/ADRD studies [Microsystem: social stressors, social support, health literacy (using “contact with health care and multivitamin use”); Exosystem: neighborhood; Macrosystem: social identity], we performed factor analysis and principal component analyses to determine the key components of SSDoH (along with education-occupation scores). Resulting composite scores were considered as covariates for incident dementia analysis using Cox Proportional Hazards models with age as the time scale. <h3>Results:</h3> Principal component (PC) analyses on the SSDoH sub-dimensions reduced variables down to ten and was further reduced to three PCs accounting for 39.2% variance in SSDoH data. The three components were: (PC1) limitations (walk/balance, visual difficulties, and health rating), education-occupation score, anxiety, and neighborhood deprivation; (PC2) Cognitive/physical activities; and (PC3) instrumental activities of daily living (iADLs), health literacy, and Rural-Urban Commuting Area (RUCA) Codes. The model estimates for the association of components with dementia risk were: (PC1) [HR=1.13 95%CI (0.95–1.35); p=0.15], (PC2) [HR= 0.85 95%CI (0.72–1.01); p=0.06] and (PC3) [HR= 1.53 95%CI (1.36–1.72); p&lt;0.001]. Even after adjusting for cognitive status, PC3 kept statistical significance (HR=1.36, 95%CI=1.21–1.54; p&lt;0.001). <h3>Conclusions:</h3> We reduced the high dimensionality of SSDoH variables and found that different groups of variables were associated differentially with dementia risk. “iADLs, health literacy, and RUCA codes” was an important aspect of SSDoH. Studies are warranted to delineate these associations further, facilitate our understanding, inform policy and intervention strategies. <b>Disclosure:</b> The institution of Dr. Vassilaki has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for F. Hoffmann-La Roche Ltd . Dr. Vassilaki has stock in Abbott Laboratories. Dr. Vassilaki has stock in Johnson and Johnson. Dr. Vassilaki has stock in Medtronic. Dr. Vassilaki has stock in Amgen. Dr. Vassilaki has stock in AbbVie. Dr. Vassilaki has stock in Merck. The institution of Dr. Vassilaki has received research support from NIH. The institution of Dr. Vassilaki has received research support from European Union/ St. Anne’s University Hospital Brno, Czech Republic. The institution of an immediate family member of Dr. Vassilaki has received research support from Avobis Bio, LLC. Jeremiah Aakre has nothing to disclose. Anna Castillo has nothing to disclose. Timothy Lesnick has received personal compensation for serving as an employee of Mayo Clinic. Dr. Graff-Radford has received personal compensation for serving as an employee of Mayo Clinic. Dr. Graff-Radford has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NINDS/NIH. Dr. Graff-Radford has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Academy of Neurology. The institution of Dr. Graff-Radford has received research support from NIH. Dr. Knopman has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for DIAN TU study. The institution of Dr. Knopman has received research support from NIH. The institution of Dr. Jack has received research support from NIH. The institution of Dr. Jack has received research support from Alexander Family Alzheimer’s Disease Research Professorship of the Mayo Clinic. Dr. Petersen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Petersen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Petersen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Petersen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Nestle. Dr. Petersen has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech, Inc.. Dr. Petersen has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche, Inc.. Dr. Petersen has received publishing royalties from a publication relating to health care. Dr. Petersen has received publishing royalties from a publication relating to health care. Dr. Vemuri has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Miller Medical Communications Inc.. The institution of Dr. Vemuri has received research support from NIH.