Abstract
Lower educational attainment is associated with a higher risk of dementia. However, less clear is the extent to which other socioeconomic markers contribute to dementia risk. To examine the relationship of education, wealth, and area-based deprivation with the incidence of dementia over the last decade in England and investigate differences between people born in different periods. Data from the English Longitudinal Study of Ageing, a prospective cohort study that is representative of the English population, were used to investigate the associations between markers of socioeconomic status (wealth quintiles and the index of multiple deprivation) and dementia incidence. To investigate outcomes associated with age cohorts, 2 independent groups were derived using a median split (born between 1902-1925 and 1926-1943). Dementia as determined by physician diagnosis and the Informant Questionnaire on Cognitive Decline in the Elderly. A total of 6220 individuals aged 65 years and older enrolled in the study (median [interquartile range] age at baseline, 73.2 [68.1-78.3] years; 3410 [54.8%] female). Of these, 463 individuals (7.4%) had new cases of dementia ascertained in the 12 years between 2002-2003 and 2014-2015. In the cohort born between 1926 and 1943, the hazard of developing dementia was 1.68 times higher (hazard ratio [HR] = 1.68 [95% CI, 1.05-2.86]) for those in the lowest wealth quintile compared with those in the highest quintile, independent of education, index of multiple deprivation, and health indicators. Higher hazards were also observed for those in the second-highest quintile of index of multiple deprivation (HR = 1.62 [95% CI, 1.06-2.46]) compared with those in the lowest (least deprived) quintile. In an English nationally representative sample, the incidence of dementia appeared to be socioeconomically patterned primarily by the level of wealth. This association was somewhat stronger for participants born in later years.
Highlights
DESIGN, SETTING, AND PARTICIPANTS Data from the English Longitudinal Study of Ageing, a prospective cohort study that is representative of the English population, were used to investigate the associations between markers of socioeconomic status and dementia incidence
In the cohort born between 1926 and 1943, the hazard of developing dementia was 1.68 times higher for those in the lowest wealth quintile compared with those in the highest quintile, independent of education, index of multiple deprivation, and health indicators
Higher hazards were observed for those in the second-highest quintile of index of multiple deprivation (HR = 1.62 [95% CI, 1.06-2.46]) compared with those in the lowest quintile
Summary
Data The English Longitudinal Study of Ageing (ELSA) is a large, multidisciplinary study representative of the English population both in terms of socioeconomic profile and geographic region.[16] There have been 7 waves of data collection over a follow-up period of up to 12 years, providing detailed information on health, well-being, and socioeconomic circumstances. We used all the available data spanning 12 years across wave 1 (20022003) to wave 7 (2014-2015). Refreshment samples were recruited at waves 3, 4, 6, and 7. We included only participants aged 65 years and older who were free of dementia at their baseline assessment at either wave 1 or through the refreshment sample of wave 4 (Figure 1 for sample selection). 724 JAMA Psychiatry July 2018 Volume 75, Number 7 (Reprinted) jamapsychiatry.com
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