背景:利用拉丁美洲的非整体结构,这代表了健康的社会决定因素(SDoH)和高水平的遗传混合的巨大变异性,我们旨在评估SDoH和遗传祖先在预测拉丁美洲人群痴呆患病率方面的相对贡献.
方法:来自古巴的65岁及以上(N=3808)的社区居住参与者,多米尼加共和国,墨西哥,秘鲁完成了10/66议定书评估。使用跨文化验证的10/66算法诊断痴呆。在主要分析中使用针对SDoH调整的多元线性回归模型。这项研究使用了1066项基于人群的研究的横断面数据。
结果:具有较高比例的美洲原住民(>70%)和非洲裔美国人(>70%)血统的人更有可能表现出导致SDoH恶化的因素,例如较低的教育水平(p<0.001),较低的社会经济地位(p<0.001),血管危险因素的频率较高(p<0.001)。在调整了SDoH的措施后,祖先比例和痴呆概率之间没有关联,和祖先比例不再显着占认知表现的差异(非洲主导p=0.31[-0.19,0.59]和本地主导p=0.74[-0.24,0.33])。
结论:研究结果表明,社会和环境因素在预测拉丁美洲人群痴呆患病率方面比遗传祖先发挥更重要的作用。这强调了需要制定解决这些社会决定因素的公共卫生战略和政策,以有效降低这些社区的痴呆症风险。
结论:拉丁美洲国家在健康和混合水平的社会决定因素方面表现出很大的差异。在调整了与SDoH相关的下游社会因素后,遗传血统表明与痴呆症没有联系。仅人口祖先特征并不影响认知表现。SDoH是痴呆症和认知表现种族差异的关键驱动因素。
Leveraging the nonmonolithic structure of Latin America, which represents a large variability in social determinants of health (SDoH) and high levels of genetic admixture, we aim to evaluate the relative contributions of SDoH and genetic
ancestry in predicting dementia prevalence in Latin American populations.
Community-dwelling participants aged 65 and older (N = 3808) from Cuba, Dominican Republic, Mexico, and Peru completed the 10/66 protocol assessments. Dementia was diagnosed using the cross-culturally validated 10/66 algorithm. Multivariate linear regression models adjusted for SDoH were used in the main analysis. This study used cross-sectional data from the 1066 population-based study.
Individuals with higher proportions of Native American (>70%) and African American (>70%)
ancestry were more likely to exhibit factors contributing to worse SDoH, such as lower educational levels (p < 0.001), lower socioeconomic status (p < 0.001), and higher frequency of vascular risk factors (p < 0.001). After adjusting for measures of SDoH, there was no association between
ancestry proportion and dementia probability, and
ancestry proportions no longer significantly accounted for the variance in cognitive performance (African predominant p = 0.31 [-0.19, 0.59] and Native predominant p = 0.74 [-0.24, 0.33]).
The findings suggest that social and environmental factors play a more crucial role than genetic ancestry in predicting dementia prevalence in Latin American populations. This underscores the need for public health strategies and policies that address these social determinants to effectively reduce dementia risk in these communities.
Countries in Latin America express a large variability in social determinants of health and levels of admixture. After adjustment for downstream societal factors linked to SDoH, genetic ancestry shows no link to dementia. Population
ancestry profiles alone do not influence cognitive performance. SDoH are key drivers of racial disparities in dementia and cognitive performance.