■属于不利的社会经济地位或社会阶层与健康结果之间的关联在近几十年来一直被记录。然而,尚未进行一项荟萃分析,以量化属于较低社会阶层与痴呆风险之间的关联.在目前的工作中,我们试图总结前瞻性的结果,关于这一主题的纵向研究。
■我们对前瞻性,纵向研究测量社会阶层指标与全因/阿尔茨海默痴呆风险之间的关联。搜索是在四个数据库中进行的(Medline,Embase,WebofScienceandPsychInfo)。本系统综述和荟萃分析的纳入标准是:(a)纵向前瞻性研究,(B)基线时年龄为60岁,(c)由一般民众发出,(d)基线时无痴呆,(e)提及社会阶层作为暴露。排除标准是:(a)研究罕见的痴呆类型(例如额颞叶痴呆),(b)只有摘要的论文和(c)没有全文的文章。纽卡斯尔-渥太华量表用于评估个体研究中的偏倚风险。我们计算了不同社会阶层指标的痴呆症总体汇总相对风险,既粗糙又适应性别,年龄和队列开始的年份。
■在4548份经过筛选的摘要中,15人被纳入最终分析(76,561名参与者,平均随访6.7年(2.4-25年),基线时的平均年龄75.1岁(70.6-82.1岁),女性的平均百分比为58%)。社会阶层是作为教育水平运作的,职业类,收入水平,邻里劣势和财富。在调整模型中,教育程度(相对风险(RR)=2.48;置信区间(CI)1.71-3.59)和职业类别(RR=2.09;CI1.18-3.69)而不是收入(RR=1.28;CI0.81-2.04)与痴呆风险显着相关。这项研究的一些局限性是纳入了主要在高收入国家进行的研究,并在我们的分析中排除了社会流动性。
■我们得出结论,属于社会阶层与痴呆症的风险之间存在显着关联,教育和职业是社会阶层对这一风险最相关的指标。研究属于弱势社会阶层与痴呆症风险之间的关系可能是随着时间的推移减少痴呆症发病率的有效途径。然而,只包括教育的社会阶级的狭隘运作,职业和收入可能会降低此类研究为社会政策提供信息的可能性。
UNASSIGNED: The association between belonging to a disadvantaged socio-economic status or social class and health outcomes has been consistently documented during recent decades. However, a meta-analysis quantifying the association between belonging to a lower social class and the risk of dementia has yet to be performed. In the present work, we sought to summarise the results of prospective, longitudinal studies on this topic.
UNASSIGNED: We conducted a systematic
review and meta-analysis of prospective, longitudinal studies measuring the association between indicators of social class and the risk of all-cause/Alzheimer\'s dementia. The search was conducted in four databases (Medline, Embase, Web of Science and PsychInfo). Inclusion criteria for this systematic
review and meta-analysis were: (a) longitudinal prospective study, (b) aged ⩾60 years at baseline, (c) issued from the general population, (d) no dementia at baseline and (e) mention of social class as exposure. Exclusion criteria were: (a) study of rare dementia types (e.g. frontotemporal dementia), (b) abstract-only papers and (c) articles without full text available. The Newcastle-Ottawa scale was used to assess the risk of bias in individual studies. We calculated the overall pooled relative risk of dementia for different social class indicators, both crude and adjusted for sex, age and the year of the cohort start.
UNASSIGNED: Out of 4548 screened abstracts, 15 were included in the final analysis (76,561 participants, mean follow-up 6.7 years (2.4-25 years), mean age at baseline 75.1 years (70.6-82.1 years), mean percentage of women 58%). Social class was operationalised as levels of education, occupational class, income level, neighbourhood disadvantage and wealth. Education (relative risk (RR)=2.48; confidence interval (CI) 1.71-3.59) and occupational class (RR=2.09; CI 1.18-3.69) but not income (RR=1.28; CI 0.81-2.04) were significantly associated with the risk of dementia in the adjusted model. Some of the limitations of this study are the inclusion of studies predominantly conducted in high-income countries and the exclusion of social mobility in our analysis.
UNASSIGNED:
We conclude that there is a significant association between belonging to a social class and the risk of dementia, with education and occupation being the most relevant indicators of social class regarding this risk. Studying the relationship between belonging to a disadvantaged social class and dementia risk might be a fruitful path to diminishing the incidence of dementia over time. However, a narrow operationalisation of social class that only includes education, occupation and income may reduce the potential for such studies to inform social policies.