A pathway from low socioeconomic status to dementia in Japan: results from the Toyama dementia survey
A pathway from low socioeconomic status to dementia in Japan: results from the Toyama dementia survey
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DOI：
10.1186/s12877-018-0791-6
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发表时间：
2018-04-27
期刊：
影响因子：
4.1
通讯作者：
Suzuki, Michio
中科院分区：
文献类型：
--
作者：
Nakahori, Nobue;Sekine, Michikazu;Suzuki, Michio
背景：据报道，在欧洲国家和美国，低社会经济地位（SES）和痴呆之间的关联是由生活方式相关疾病（即糖尿病）介导的；然而，在日本，低社会经济地位和痴呆之间的联系还没有被调查。本研究评估了日本生活方式相关疾病在低社会经济地位和痴呆之间的中介作用的可能性。方法：采用回顾性病例对照研究设计，数据来自日本富山痴呆调查。随机选取富山县居住的年龄在bb0 = 65岁（收容和非收容）的个体，抽样率为0.5%。其中1303人同意参与，应答率84.8%。总的来说，137例痴呆和1039例未受损的对照组被确定。如有必要，对参与者及其家庭成员或代理人进行结构化访谈。评估了参与者的医学诊断病史、生活方式因素（即吸烟和饮酒习惯）和SES（受教育程度和职业史）。低社会经济地位通过生活方式相关疾病成为痴呆风险因素的可能性采用Sobel检验。结果：受教育程度低（6年或以下）的受试者患痴呆的比值比（OR）高于受教育程度高的受试者[年龄和性别调整比值比为3.27；95%置信区间（CI） 1.84-5.81]；蓝领工作经历的参与者也比白领工作经历的参与者更高（调整年龄和性别的OR为1.26；95% CI为0.80-1.98）。在调整工作经历后，受教育程度低的参与者患痴呆症的OR为3.23-3.56。以前习惯性饮酒和有糖尿病、帕金森病、中风、心绞痛/心血管疾病病史的人患痴呆的风险增加。受教育程度与饮酒、吸烟、糖尿病、帕金森病、中风或心血管疾病无关。职业史与糖尿病和中风有关。研究发现，糖尿病在低受教育程度和痴呆中的作用非常有限。结论：在日本，生活方式相关疾病在低社会经济地位与痴呆之间的中介作用很小。
Background: The association between low socioeconomic status (SES) and dementia is reportedly mediated by lifestyle-related diseases (i.e., diabetes) in European countries and the United States; however, in Japan, the link between low SES and dementia has not been investigated. This study evaluated the possibility of a mediating role of lifestyle-related diseases in the relationship between low SES and dementia in Japan.Methods: A retrospective case-control study design, with data from the Toyama Dementia Survey, Japan, was used. Individuals aged >= 65 years (institutionalized and noninstitutionalized) living in Toyama prefecture were randomly selected, with a sampling rate of 0.5%. Of them, 1303 agreed to participate (response rate 84.8%). Overall, 137 cases of dementia and 1039 unimpaired controls were identified. Structured interviews with participants and family members or proxies were conducted, if necessary. Participants' history of medically diagnosed disease, lifestyle factors (i.e., smoking and alcohol drinking habits), and SES (educational attainment and occupational history) were assessed. The possibility of low SES being a risk factor for dementia via lifestyle-related diseases was investigated using the Sobel test.Results: The odds ratio (OR) for dementia was higher for participants with low educational attainment (6 years or less) than for highly educated participants [age-and sex-adjusted OR 3.27; 95% confidence interval (CI) 1.84-5.81]; it was also higher for participants with a blue-collar job history than a white-collar job history (age-and sex-adjusted OR 1.26; 95% CI 0.80-1.98). After adjustment for employment history, the OR for dementia for participants with low educational attainment was 3.23-3.56. Former habitual alcohol consumption and a medical history of diabetes, Parkinson's disease, stroke, and angina pectoris/cardiovascular disease were found to increase the risk of dementia. Educational attainment was not associated with alcohol consumption, smoking, diabetes, Parkinson's disease, stroke, or cardiovascular disease. Occupational history was associated with diabetes and stroke. The role of diabetes in low educational attainment and dementia was found to be extremely limited.Conclusions: In Japan, lifestyle-related diseases play a minimal role as mediators between low SES and dementia.