Multi-country dementia study shows women’s greater risk may be linked to disadvantage
A large international study of dementia risk involving almost 30,000 people from 18 countries covering all six continents suggests that social and economic disadvantage may explain the higher risk of the condition in women.
Although there was almost no evidence of sex differences in most of the known risk factors for developing dementia, the higher likelihood of women developing the condition was more pronounced in poorer countries.
Lead author Jessica Gong, from The George Institute for Global Health, said that while previous research had shown women have a greater lifetime risk of developing dementia than men, partly because they tend to live longer, age alone may not fully account for this difference.
“Most research estimating dementia incidence to date has been conducted in high-income countries, with very little data available in the countries that actually bear the greatest burden,” she said.
“We found that when adjusted for age, rates of dementia were highest among low- to lower-middle income countries, and higher in women than men.”
The number of people living with dementia is projected to exceed 150 million by 2050 worldwide, three times the 2019 estimate of 50 million. Rates are increasing most rapidly in low- and middle-income countries (LMICs) that are less able to manage the significant economic and societal impact of this devastating disease.
In 2020 the Lancet Commission Report estimated that as much as 40 percent of dementia risk could be attributed to 12 modifiable risk factors, many of which are more common in LMICs. They include less education, hypertension, obesity, diabetes, depression, hearing impairment, smoking, excessive alcohol consumption, physical inactivity, low social contact, traumatic brain injury, and air pollution.
“When we looked for sex differences in these risk factors, we found that, older age, diabetes, depression, hearing impairment and having a certain genetic variation involved in fat metabolism in the brain – known as APOE4 - were associated with a greater risk of dementia in both women and men,” Ms Gong said.
“While more years of education, higher hip circumference, current alcohol use (versus never drinking) and high physical activity (versus none to minimal activity) were associated with a lower risk of dementia in both sexes.
“But there was moderate evidence for a sex difference with years spent in education, indicating a stronger protective association for men than women.”
The authors argued that women, particularly in LMICs, have not had equal educational and occupational opportunities to men, and higher educational attainment and mentally stimulating occupations have been shown to be protective against dementia.
Associate Professor Sanne Peters, a Senior Lecturer at The George Institute for Global Health UK in partnership with Imperial College London and part of the research team, said that institutional factors restricting women’s opportunities, reduced access to appropriate healthcare and risk management programs, as well as other factors such as domestic violence - particularly for women from lower socioeconomic settings - can lead to psychological stress and leave them in worse financial positions, affecting their late-life cognitive health.
“In general, the geographical patterns that we saw for increased dementia risk in women seemed to echo those of gender disparity,” she said.
“These findings justify support for programs to improve gender equity in brain health throughout the life-course, particularly in populations that have been previously underrepresented in dementia research.”
METHOD OF RESEARCH
Meta-analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Sex differences in dementia risk and risk factors: Individual-participant data analysis using 21 cohorts across six continents from the COSMIC consortium
ARTICLE PUBLICATION DATE
15-Feb-2023
COI STATEMENT
B.S.D. has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from UOL Tecnologia Educacional, Brazil; and participates on a Data Safety Monitoring Board or Advisory Board for Depression treatment and Aβ dynamics: A study of Alzheimer’s disease risk (ABD Study) (1 R01 AG070821-01A1). R.B.L. received funding support from NIH/NIA 2PO1 AG003949 (Einstein Aging Study), S&L Marx Foundation, Czap Foundation; grants from the FDA, the Migraine Research Foundation, and the National Headache Foundation; served as consultant, advisory board member, and received honoraria from or research support from: Abbvie (Allergan), American Academy of Neurology, American Headache Society, Amgen, Biohaven, Biovision, Boston, Dr. Reddy’s (Promius), Electrocore, Eli Lilly, eNeura, Equinox GlaxoSmithKline, Grifols, Lundbeck (Alder), Merck, Pernix, Pfizer, Teva, Vector, and Vedanta; and has stock in Biohaven and Manistee. M.J.K. is supported by NIH/NIA AG03949. C.W. is supported by NIH/NIA AG003949. M.G. is supported by French National Research Agency, AXA Research Fund, and Limoges University Hospital (France). N.S. is supported by Alzheimer’s Association grant IIRG-09-133014, Euro pean Social Fund grants 189 10276/8/9/2011, National Strategic Reference Framework-EU program Excellence Grant (ARISTEIA), and Greek Ministry of Health grants DY2b/oik.51657/14.4.2009, as well as EPAD—Local PI of recruiting site for multinational, multicenter Innovative Medicines Initiative (IMI) sponsored observational study of prodromal stages of dementia, and NovoNordisk—Local PI of recruiting site for multinational, multicenter industry sponsored phase III treatment trial for Alzheimer’s disease; and served on the Chair of Data Safety Monitoring Board for Albert Einstein College of Medicine—NIH funded study. M.Y. is supported by European Social Fund and Ministry of Health, and received fundings from ERASMUS+—European Commission and HORIZON2020 – European Commission; served as the President of the National Nutrition Policy Committee – no fees. M.G. is supported by the National Institute on Aging, NIH, received payments from the University of Connecticut Health Center for honoraria for lectures; participated on a Data Safety Monitoring Board or Advisory Board for Indiana University School of Medicine; and received honorarium payment from the Journal of the American Geriatrics Society. C.C.C. is supported by the NIH (R01 grant: MYHAT study). A.L. and ZARADEMP study was supported by grants from the Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spanish Ministry of Economy and Competitiveness, Madrid, Spain (grants 94/1562, 97/1321E, 98/0103, 01/0255, 03/0815, 06/0617, G03/128, 12/02254, 16/00896, 19/01874), and the Fondo Europeo de Desarrollo Regional (FEDER) of the European Union and Gobierno de Aragón, (grant B15_17R). Group #19; A.L. received financial support to attend scientific meeting from Janssen. E.L. has received honorarium from University of Granada. None of these activities was related to the current project. M.W. is supported by Australian NHMRC and EU Horizon 2020, and is a consultant for Amgen and Freeline outside the submitted work; and participated on a Data Safety Monitoring Board or Advisory Board for DMB STAREE trial (no payment). The rest of the authors have no conflicts of interest. C.D.L.C. has received financial support to attend scientific meetings from Janssen, Almirall, Lilly, Lundbeck, Rovi, Esteve, Novartis, Astrazeneca, Pfizer, and Casen Recordati. M.W. has been a consultant for Amgen, Freeline, and Kirin outside the submitted work.
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