背景:与高收入经济体相比,低收入和中等收入国家(LMICs)的非痴呆认知障碍(CIND)和痴呆的患病率似乎更高。然而,很少有来自拉丁美洲LMICs的全国代表性研究调查了与对这两种认知状况的易感性相关的生命过程社会经济因素。因此,本研究旨在检查早期(教育和粮食不安全)的关联,中期(就业稳定),以及巴西老年人中CIND和痴呆症的晚年(个人收入和家庭人均收入)社会经济决定因素,同时探索性别是否在这些关联中起作用修饰作用。
方法:这项基于人群的研究包括来自巴西老龄化纵向研究(ELSI-Brazil)的60岁及以上老年人(N=5,249)的全国代表性样本。我们用相应的95%置信区间(CI)拟合多项回归和估计赔率比。
结果:在多变量分析中,早期教育年限(0.89,95%CI[0.81,0.97])和中年就业稳定性(0.97,95%CI[0.96,0.99])以及晚年家庭人均收入较高(0.70,95%CI[0.51,0.95)的参与者患痴呆的可能性较小.关于CIND,更多年的中年就业稳定性(0.97,95%CI[0.96,0.98])是赋予保护的唯一决定因素。值得注意的是,次要基于性别的分析表明,早期教育程度越高,女性患痴呆的几率越低(0.81,95%CI[0.75,0.87]),而男性患痴呆的几率越低(1.00,95%CI[0.86,1.16]).
结论:这些发现可能通过提高我们对CIND和痴呆症的社会经济决定因素的理解,对人口健康和健康政策产生影响。尤其是在拉丁美洲。
BACKGROUND: The prevalence of cognitive impairment no dementia (CIND) and dementia appears to be higher in low- and middle-income countries (LMICs) compared to high-income economies. Yet few nationally representative studies from Latin American LMICs have investigated life-course socioeconomic factors associated with the susceptibility to these two cognitive conditions. Hence, the present
study aimed to examine the associations of early- (education and food insecurity), mid- (employment stability), and late-life (personal income and household per capita income) socioeconomic determinants of CIND and dementia among older adults from Brazil, while simultaneously exploring whether sex plays an effect-modifier role on these associations.
METHODS: This population-based
study comprised a nationally representative sample of older adults (N = 5,249) aged 60 years and over from the Brazilian Longitudinal
Study of Aging (ELSI-Brazil). We fitted multinomial regressions and estimated odds ratios with the respective 95% confidence intervals (CIs).
RESULTS: In multivariate analyses, participants with more years of early-life education (0.89, 95% CI [0.81, 0.97]) and mid-life employment stability (0.97, 95% CI [0.96, 0.99]) and higher late-life household per capita income (0.70, 95% CI [0.51, 0.95) were less likely to have dementia. Regarding CIND, more years of mid-life employment stability (0.97, 95% CI [0.96, 0.98]) was the only determinant to confer protection. Notably, secondary sex-based analyses showed the higher the early-life educational attainment, the lower the odds of dementia in women (0.81, 95% CI [0.75, 0.87]) but not in men (1.00, 95% CI [0.86, 1.16]).
CONCLUSIONS: These findings may have implications for population health and health policy by advancing our understanding of socioeconomic determinants of CIND and dementia, especially in Latin America.