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Temporal trends in population attributable fractions of modifiable risk factors for dementia: a time-series study of the English Longitudinal Study of Ageing (2004-2019)

Temporal trends in population attributable fractions of modifiable risk factors for dementia: a time-series study of the English Longitudinal Study of Ageing (2004-2019)
Temporal trends in population attributable fractions of modifiable risk factors for dementia: a time-series study of the English Longitudinal Study of Ageing (2004-2019)
Background: interest in modifiable risk factors (MRFs) for dementia is high, given the personal, social, and economic impact of the disorder, especially in ageing societies such as the United Kingdom. Exploring the population attributable fraction (PAF) of dementia attributable to MRFs and how this may have changed over time remains unclear. Unravelling the temporal dynamics of MRFs is crucial for informing the development of evidence-based and effective public health policies. This investigation examined the temporal trajectories of MRFs for dementia in England.

Methods: we used data from the English Longitudinal Study of Ageing, a panel study over eight waves collected between 2004 and 2019 (76,904 interviews in total). We calculated the PAFs for twelve MRFs (including six early- to mid-life factors and six late-life factors), as recommended by the Lancet Commission, and the individual weighted PAFs (IW-PAFs) for each risk factor. Temporal trends were analysed to understand the changes in the overall PAF and IW-PAF over the study period. Subgroup analyses were conducted by sex and socioeconomic status (SES).

Results: the overall PAF for dementia MRFs changed from 46.73% in 2004/2005 to 36.79% in 2018/2019, though this trend was not statistically significant. During 2004–2019, hypertension, with an average IW-PAF of 8.21%, was the primary modifiable determinant of dementia, followed by obesity (6.16%), social isolation (5.61%), hearing loss (4.81%), depression (4.72%), low education (4.63%), physical inactivity (3.26%), diabetes mellitus (2.49%), smoking (2.0%), excessive alcohol consumption (1.16%), air pollution (0.42%), and traumatic brain injury (TBI) (0.26%). During 2004–2019, only IW-PAFs of low education, social isolation, and smoking showed significant decreasing trends, while IW-PAFs of other factors either did not change significantly or increased (including TBI, diabetes mellitus, and air pollution). Upon sex-specific disaggregation, a higher overall PAF for MRFs was found among women, predominantly associated with later-life risk factors, most notably social isolation, depression, and physical inactivity. Additionally, hearing loss, classified as an early- to mid-life factor, played a supplementary role in the identified sex disparity. A comparable discrepancy was evident upon PAF evaluation by SES, with lower income groups experiencing a higher dementia risk, largely tied to later-life factors such as social isolation, physical inactivity, depression, and smoking. Early- to mid-life factors, in particular, low education and obesity, were also observed to contribute to the SES-associated divergence in dementia risk. Temporal PAF and IW-PAF trends, stratified by sex and SES, revealed that MRF PAF gaps across sex or SES categories have persisted or increased.

Conclusions: in England, there was little change over time in the proportion of dementia attributable to known modifiable risk factors. The observed trends underscore the continuing relevance of these risk factors and the need for targeted public health strategies to address them.
Aged, Aged, 80 and over, Aging, Dementia/epidemiology, England/epidemiology, Female, Humans, Longitudinal Studies, Male, Middle Aged, Risk Factors, England, Population attributable fractions, Disparity, Dementia, Temporal trend
1741-7015
Chen, Shanquan
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Underwood, Benjamin R.
e288c7ea-daca-4ed5-a872-d81e9486057c
Cardinal, Rudolf N.
1fe91ac7-8f89-4064-90a3-26dc097ba229
Chen, Xi
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Chen, Shu
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Chen, Shu
6573ef13-4f78-4cfe-a152-9cb9aa08478c
Amin, Jay
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Jin, Huajie
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Huang, Jing
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Mueller, Christoph
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Yan, Lijing L.
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Brayne, Carol
978cfad1-c7f6-4f79-aa1c-4f189eaaf035
Kuper, Hannah
bfd30443-06e7-44fd-aab2-8d31c07c8bee
Chen, Shanquan
1c09ca67-e1f6-4ac7-acd8-ac09c4060e18
Underwood, Benjamin R.
e288c7ea-daca-4ed5-a872-d81e9486057c
Cardinal, Rudolf N.
1fe91ac7-8f89-4064-90a3-26dc097ba229
Chen, Xi
b3f41cd9-57e0-48e3-8a1c-f9bdf7367742
Chen, Shu
6d6c193c-b6b3-43b4-8eaa-f1d34ce0c564
Chen, Shu
6573ef13-4f78-4cfe-a152-9cb9aa08478c
Amin, Jay
692a8880-70ff-4b64-a7e9-7d0d53449a30
Jin, Huajie
fad20429-e6f2-40cb-aabe-f5e71322fa99
Huang, Jing
3284f428-af19-4d3c-ad1c-73ec71a7d115
Mueller, Christoph
46065008-a3e2-4512-85bd-b2d7218300c2
Yan, Lijing L.
e46c3676-3ae5-40b6-b09f-2476d8134ff5
Brayne, Carol
978cfad1-c7f6-4f79-aa1c-4f189eaaf035
Kuper, Hannah
bfd30443-06e7-44fd-aab2-8d31c07c8bee

Chen, Shanquan, Underwood, Benjamin R., Cardinal, Rudolf N., Chen, Xi, Chen, Shu, Chen, Shu, Amin, Jay, Jin, Huajie, Huang, Jing, Mueller, Christoph, Yan, Lijing L., Brayne, Carol and Kuper, Hannah (2024) Temporal trends in population attributable fractions of modifiable risk factors for dementia: a time-series study of the English Longitudinal Study of Ageing (2004-2019). BMC Medicine, 22 (1), [268]. (doi:10.1186/s12916-024-03464-2).

Record type: Article

Abstract

Background: interest in modifiable risk factors (MRFs) for dementia is high, given the personal, social, and economic impact of the disorder, especially in ageing societies such as the United Kingdom. Exploring the population attributable fraction (PAF) of dementia attributable to MRFs and how this may have changed over time remains unclear. Unravelling the temporal dynamics of MRFs is crucial for informing the development of evidence-based and effective public health policies. This investigation examined the temporal trajectories of MRFs for dementia in England.

Methods: we used data from the English Longitudinal Study of Ageing, a panel study over eight waves collected between 2004 and 2019 (76,904 interviews in total). We calculated the PAFs for twelve MRFs (including six early- to mid-life factors and six late-life factors), as recommended by the Lancet Commission, and the individual weighted PAFs (IW-PAFs) for each risk factor. Temporal trends were analysed to understand the changes in the overall PAF and IW-PAF over the study period. Subgroup analyses were conducted by sex and socioeconomic status (SES).

Results: the overall PAF for dementia MRFs changed from 46.73% in 2004/2005 to 36.79% in 2018/2019, though this trend was not statistically significant. During 2004–2019, hypertension, with an average IW-PAF of 8.21%, was the primary modifiable determinant of dementia, followed by obesity (6.16%), social isolation (5.61%), hearing loss (4.81%), depression (4.72%), low education (4.63%), physical inactivity (3.26%), diabetes mellitus (2.49%), smoking (2.0%), excessive alcohol consumption (1.16%), air pollution (0.42%), and traumatic brain injury (TBI) (0.26%). During 2004–2019, only IW-PAFs of low education, social isolation, and smoking showed significant decreasing trends, while IW-PAFs of other factors either did not change significantly or increased (including TBI, diabetes mellitus, and air pollution). Upon sex-specific disaggregation, a higher overall PAF for MRFs was found among women, predominantly associated with later-life risk factors, most notably social isolation, depression, and physical inactivity. Additionally, hearing loss, classified as an early- to mid-life factor, played a supplementary role in the identified sex disparity. A comparable discrepancy was evident upon PAF evaluation by SES, with lower income groups experiencing a higher dementia risk, largely tied to later-life factors such as social isolation, physical inactivity, depression, and smoking. Early- to mid-life factors, in particular, low education and obesity, were also observed to contribute to the SES-associated divergence in dementia risk. Temporal PAF and IW-PAF trends, stratified by sex and SES, revealed that MRF PAF gaps across sex or SES categories have persisted or increased.

Conclusions: in England, there was little change over time in the proportion of dementia attributable to known modifiable risk factors. The observed trends underscore the continuing relevance of these risk factors and the need for targeted public health strategies to address them.

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Accepted/In Press date: 3 June 2024
Published date: 26 June 2024
Additional Information: For the purpose of open access, the authors have applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising from this submission.
Keywords: Aged, Aged, 80 and over, Aging, Dementia/epidemiology, England/epidemiology, Female, Humans, Longitudinal Studies, Male, Middle Aged, Risk Factors, England, Population attributable fractions, Disparity, Dementia, Temporal trend

Identifiers

Local EPrints ID: 492887
URI: http://eprints.soton.ac.uk/id/eprint/492887
ISSN: 1741-7015
PURE UUID: 37771743-4545-4211-bc17-e590a8e2ac18
ORCID for Jay Amin: ORCID iD orcid.org/0000-0003-3792-0428

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Date deposited: 19 Aug 2024 16:47
Last modified: 05 Oct 2024 01:51

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Contributors

Author: Shanquan Chen
Author: Benjamin R. Underwood
Author: Rudolf N. Cardinal
Author: Xi Chen
Author: Shu Chen
Author: Shu Chen
Author: Jay Amin ORCID iD
Author: Huajie Jin
Author: Jing Huang
Author: Christoph Mueller
Author: Lijing L. Yan
Author: Carol Brayne
Author: Hannah Kuper

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