Abstract
BackgroundOld-age dementias are known to disproportionally affect women as well as individuals with low educational attainment. The higher lifetime risk of dementia among women is usually attributed to their longer life expectancy. However, the impact of sex, and subsequent gender inequity, is likely to be more multifaceted than this explanation implies. Not least because of historical inequities in access to education between the sexes and the gender and socio-economic gradients in risk factors such as stress, depression and social isolation. Consequently, the present study sought to test whether differences in educational attainment and experiences of general psychological distress mediate the association between female sex and dementia.MethodsThe study utilizes data obtained through the Gothenburg H70 Birth Cohort Study and the Prospective Populations Study on Women (n = 892). Data were analysed using Confirmatory Factor Analysis (CFA) and Structural Equation Modelling (SEM) with Weighted Least Squares Means and Variance adjusted (WLSMV) estimation. General psychological distress was indicated by a latent variable and constructed from five manifest items (previous depression, stress, self-esteem, chronic loneliness and satisfaction with social situation) that were all measured at baseline.ResultsWhile the results could not corroborate that education directly mediates the effect of sex on dementia, level of distress was predicted by both female sex (0.607, p < .001) and education (− 0.166, p < .01) and, in turn, shown to be significantly associated with dementia (0.167, p < .05), also after controlling for confounders. When time from baseline to diagnosis was increased through sequential exclusion of dementia cases, the effect of distress on dementia was no longer significant.ConclusionThe overall findings suggest that social (dis) advantage predicts general psychological distress, which thereby constitutes a potential, and rarely acknowledged, pathway between female sex, education, and dementia. They further underline the importance of attending to both education and distress as ‘gendered’ phenomena when considering the nature of their associations with dementia. However, the possibility of reverse causality bias must be acknowledged and the need for longitudinal studies with longer follow-up stressed.
Highlights
Old-age dementias are known to disproportionally affect women as well as individuals with low educational attainment
When the hypothesized measurement model was fitted to the data, all indicators were shown to be significantly related to the latent construct
The present study found that social advantage, here indicated by female sex and low educational attainment, predicts general psychological distress in older individuals without dementia, regardless of whether it should be regarded as a risk factor or pre-diagnostic sign
Summary
Old-age dementias are known to disproportionally affect women as well as individuals with low educational attainment. The higher lifetime risk of dementia among women is usually attributed to their longer life expectancy. The major genetic risk factor for AD is the apolipoprotein E (APOE) ɛ4 allele, which is a non-causative mutation known to increase disease risk by between three and 15 times [8, 9]. Old-age dementias, AD, are further known to disproportionally affect women and individuals with lower educational attainment [1, 10, 11]. At age 65, 1 in 7 men are projected to develop the disease during their remaining life span, which yields a lifetime risk of approximately 14%. The corresponding estimate for women is 20% [18]
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