Racial disparities in predictors of dementia in a population‐based cohort

Abstract

AbstractBackgroundIdentifying predictors of dementia may reduce its burden across the globe. Herein, we aimed at investigating predictors of probable dementia in different race groups of a middle‐income country.MethodThe ELSI‐Brazil cohort consists of 9412 individuals (63.55+‐10.14 years of age). This cohort comprises individuals at/ or above 50 years of age from across the country. Complex sampling warrants nationwide representativity for diseases with low prevalence. Probable dementia was defined as a brief cognitive screening (using category fluency test) score below normative data for age and education, associated with a Katz scale score below 6. Multivariate logistic regression models were performed to measure predictors of dementia in Black, Brown, White and Indigenous individuals. Asian ancestry individuals were excluded from this analysis due to the small sample size (n = 90).ResultThe frequency of individuals with probable dementia was statistically similar between groups, especifically 8.7% (n = 74/887) in black individuals, 7.8% (n = 17/220) in indigenous individuals, 7.5% (n = 301/4283) in Brown individuals, and 7.2% (n = 245/3590) in White individuals (p = 0.51). Indigenous individuals with probable dementia were significantly younger than other groups (59.1 years, p<0.001). Predictors of dementia differ significantly between groups, except for depression, which was the only predictor universally present. In Brown individuals, stroke and myocardial infarction were associated with predictors of dementia (OR: 2.34 [1.5 ‐ 3.5] and OR: 2.57 [1.69 ‐ 3.84] respectively), while the feeling of loneliness (OR: 1.69 [1.20 ‐ 2.42]) and being economically inactive (OR: 2.89 [1.68 ‐ 4.80]) were associated with dementia in White individuals. In Black individuals, recent hospitalization was a strong predictor (OR: 2.86 [1.47 ‐ 5.42]), while in Indigenous individuals, only depression was a predictor (OR: 19.22 [3.74 ‐ 352]), potentially associated with its small sample.ConclusionDistinct profile of predictors for probable dementia should be accounted for when evaluating distinct races groups. While depression was a predictor for all races, Brown individuals presented a clinical profile more vulnerable to cardiovascular events.