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Socioeconomic inequalities in dementia risk among a French population-based cohort: quantifying the role of cardiovascular health and vascular events.
- Source :
-
European journal of epidemiology [Eur J Epidemiol] 2021 Oct; Vol. 36 (10), pp. 1015-1023. Date of Electronic Publication: 2021 Jul 25. - Publication Year :
- 2021
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Abstract
- This study aimed to investigate the role of cardiovascular health (CVH) and vascular events as potential contributors to socioeconomic inequalities in dementia using causal mediation analyses. We used data from the Three-City Cohort, a French population-based study with 12 years of follow-up, with active search of dementia cases and validated diagnosis. Individual socioeconomic status was assessed using education, occupation and income. A CVH score as defined by the American Heart Association and incident vascular events were considered separately as mediators. We performed multi-level Cox proportional and Aalen additive hazard regression models to estimate the total effects of socioeconomic status on dementia risk. To estimate natural direct and indirect effects through CVH and vascular events, we applied two distinct weighting methods to quantify the role of CVH and vascular events: Inverse Odds Ratio Weighting (IORW) and Marginal Structural Models (MSM) respectively. Among 5581 participants, the risk of dementia was higher among participants with primary education (HR 1.60, 95%CI 1.44-1.78), blue-collar workers (HR 1.62, 95%CI 1.43-1.84) and with lower income (HR 1.23, 95%CI 1.09-1.29). Using additive models, 571 (95% CI 288-782) and 634 (95% CI 246-1020) additional cases of dementia per 100 000 person and year were estimated for primary education and blue-collar occupation, respectively. Using IORW, the CVH score mediate the relationship between education or income, and dementia (proportion mediated 17% and 26%, respectively). Yet, considering vascular events as mediator, MSM generated indirect effects that were smaller and more imprecise. Socioeconomic inequalities in dementia risk were observed but marginally explained by CVH or vascular events mediators.<br /> (© 2021. The Author(s).)
- Subjects :
- Aged
Cardiovascular Diseases epidemiology
Dementia epidemiology
Dementia etiology
Female
Health Status Disparities
Health Status Indicators
Humans
Male
Mediation Analysis
Residence Characteristics statistics & numerical data
Cardiovascular Diseases complications
Dementia diagnosis
Health Behavior
Social Class
Social Determinants of Health
Subjects
Details
- Language :
- English
- ISSN :
- 1573-7284
- Volume :
- 36
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- European journal of epidemiology
- Publication Type :
- Academic Journal
- Accession number :
- 34308532
- Full Text :
- https://doi.org/10.1007/s10654-021-00788-8