Abstract
BackgroundSocioeconomic level of residential environment was found to influence cognitive performance. However, individuals from the same place of residence may be affected differently. We aim to investigate for the first time the influence of individual activity space on the association between neighborhood socioeconomic status (NSES) and the risk of dementia.MethodsIn the frame of the Three-City cohort, a French population-based study, we followed longitudinally (12 years) 7009 participants aged over 65. The activity space (i.e., the spatial area through which a person moves daily) was defined using two questions from Lawton’s Instrumental Activities of Daily Living scale (“Goes shopping independently”,“Travels alone”), and one question about mobility restriction. The survival analysis was performed using a Cox marginal model that takes into account intra-neighborhood correlations and includes a large number of potential confounders.ResultsAmong people with a limited activity space (n = 772, 11%), risk of dementia is increased in subjects living in a deprived area (characterized by high GINI index or low median income) compared to those living in more favored.ConclusionThis study shows that the individual activity space modifies the association between NSES and the risk of dementia providing a more complete picture of residential inequalities. If confirmed in different populations, these findings suggest that people with limited activity space and living in a deprived neighborhood are particularly at risk and should be targeted for prevention.
Highlights
Socioeconomic level of residential environment was found to influence cognitive performance
Based on the hypothesis that the activity space might contribute to inequalities in the contextual exposure to deprivation and resource access [17, 20], we investigated whether activity space modifies the relation between living environment and dementia risk in a cohort of community-living older people
Subjects characteristics Among the 7009 people retained for this study (54,857 person-years), 789 developed incident dementia over the 12-year follow-up period, corresponding to an annual incidence rate of 14.4/1000 py
Summary
Socioeconomic level of residential environment was found to influence cognitive performance. We aim to investigate for the first time the influence of individual activity space on the association between neighborhood socioeconomic status (NSES) and the risk of dementia. We showed that the risk of dementia is increased only in women living in the most deprived neighborhoods [9] Such effect of contextual risk factors on dementia incidence only in women might be related by their greater propensity to perform their activities in their neighborhood of residence. Women of this generation are less likely to work and to have a driving license, and live more often alone
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