The role of social deprivation and depression in dementia risk: findings from the longitudinal survey of health, ageing and retirement in Europe

Abstract

Aims Knowledge on the link of individual social deprivation with dementia is incomplete. We thus aimed to see whether an association with dementia risk can be observed using a recently developed Social Deprivation Index (SoDep Index). Further, as deprivation is related to depression, we investigated the role of depression in the association. Methods We analysed data of 11 623 Survey of Health, Ageing and Retirement in Europe (SHARE) respondents. Social deprivation status was determined by SoDep Index score. Dementia was determined by self-reported diagnosis. Dementia risk by social deprivation status was estimated using Cox proportional hazard models, including relevant covariates (gender, marriage status, chronic conditions). Depressive symptom status was added in a second step. Further, we completed subgroup analyses by social deprivation status and analysed the relevance of depressive symptoms in dementia risk in each deprivation group. In an additional sensitivity analyses we corrected for mortality and used impaired cognitive testing performance as an alternative outcome. Results High (v. low) social deprivation status was associated with an increased dementia risk (hazard ratio (HR) = 1.79 [95% CI 1.31–2.45]) in the Cox analysis adjusted for covariates only. Further adjustment for depressive symptom status indicated a largely direct association between social deprivation status and dementia risk. Moreover, compared to not having experienced depressive symptoms in the past or at baseline, those with past (HR = 1.67 [95% CI 1.23–2.25]), baseline (HR = 1.48 [95% CI 1.04–2.10]) or stable depressive symptoms (HR = 2.96 [95% CI 2.12–4.14]) had an increased dementia risk. The association between stable depressive symptom status and dementia risk was in the high social deprivation subgroup particularly pronounced. Sensitivity analyses replicated results. Conclusions Results add to a growing body of evidence indicating that a public health approach to dementia prevention must address socioeconomic inequity. Results suggest a largely direct association between social deprivation and dementia risk. Adults who experience high social deprivation appear particularly affected by detrimental effects of depressive symptomatology on dementia risk and need intervention.

Estimating the prevalence of diagnosed Alzheimer disease in England across deprivation groups using electronic health records: a clinical practice research datalink study

“…The observed pattern of prevalence with deprivation among the analyses stratified by age and age-sex indicates a positive correlation between deprivation and AD diagnosis, that is, higher levels of deprivation are associated with higher levels of AD diagnosis. This pattern has also been observed in dementia 21 28 34 35. Further, this link has also been explored in genetic biobank studies and have found the same conclusion 15 36.…”

Has COVID‐19 affected dementia diagnosis rates in England?

“…It is of note that the DDR does not currently inform on the NHS's performance in diagnosing young‐onset dementia, 35 as this population was not included in CFAS II (although the total number of people aged under 65 with dementia is published alongside the DDR. Furthermore, a more granular understanding of dementia prevalence at local level, in which the DDR denominator is adjusted for factors known to affect dementia susceptibility such as deprivation, rurality, and ethnicity will also increase the utility of the DDR as an instrument which guides public policy 36–42 . Nevertheless, the DDR (perhaps because of its form—a simple percentage rate accessible to all) has maintained the profile of access to diagnosis, an essential element in the dementia pathway.…”

“…Furthermore, a more granular understanding of dementia prevalence at local level, in which the DDR denominator is adjusted for factors known to affect dementia susceptibility such as deprivation, rurality, and ethnicity will also increase the utility of the DDR as an instrument which guides public policy. 36 , 37 , 38 , 39 , 40 , 41 , 42 Nevertheless, the DDR (perhaps because of its form—a simple percentage rate accessible to all) has maintained the profile of access to diagnosis, an essential element in the dementia pathway.…”

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