Socioeconomic Position and Late-Onset Dementia: A Nationwide Register-Based Study

Objectives Previous research on the association between socioeconomic position (SEP) and dementia has not sufficiently accounted for the complex relationship between education and occupation. We investigated the independent and joint effects of educational attainment and occupation-based SEP on dementia. Methods We used register-based information about educational attainment, occupation-based SEP, and dementia from 1,210,720 individuals. Information about cognitive ability at conscription was available for a subsample of men. Results When mutually adjusted, lower educational attainment and occupation-based SEP were associated with higher dementia risk in a dose–response manner. Higher occupation-based SEP partly mitigated the higher dementia risk associated with lower educational attainment. After adjusting for cognitive ability in a subgroup of men, only unskilled work was associated with higher dementia risk. Discussion Occupation-based SEP is independently associated with dementia and may mitigate the higher dementia risk associated with short education. Future research should elucidate the mechanisms underlying social inequality in dementia.

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Does smoking cause lower educational attainment and general cognitive ability? Triangulation of causal evidence using multiple study designs

Psychological Medicine ◽

10.1017/s0033291720003402 ◽

2020 ◽

pp. 1-9

Author(s):

Suzanne H. Gage ◽

Hannah M. Sallis ◽

Glenda Lassi ◽

Robyn E. Wootton ◽

Claire Mokrysz ◽

...

Keyword(s):

Educational Attainment ◽

Cognitive Ability ◽

Fluid Intelligence ◽

Causal Effect ◽

Smoking Initiation ◽

Sensitivity Analyses ◽

Mendelian Randomisation ◽

General Cognitive Ability ◽

Inverse Variance ◽

Lower Educational Attainment

Abstract Background Observational studies have found associations between smoking and both poorer cognitive ability and lower educational attainment; however, evaluating causality is challenging. We used two complementary methods to explore this. Methods We conducted observational analyses of up to 12 004 participants in a cohort study (Study One) and Mendelian randomisation (MR) analyses using summary and cohort data (Study Two). Outcome measures were cognitive ability at age 15 and educational attainment at age 16 (Study One), and educational attainment and fluid intelligence (Study Two). Results Study One: heaviness of smoking at age 15 was associated with lower cognitive ability at age 15 and lower educational attainment at age 16. Adjustment for potential confounders partially attenuated findings (e.g. fully adjusted cognitive ability β −0.736, 95% CI −1.238 to −0.233, p = 0.004; fully adjusted educational attainment β −1.254, 95% CI −1.597 to −0.911, p < 0.001). Study Two: MR indicated that both smoking initiation and lifetime smoking predict lower educational attainment (e.g. smoking initiation to educational attainment inverse-variance weighted MR β −0.197, 95% CI −0.223 to −0.171, p = 1.78 × 10−49). Educational attainment results were robust to sensitivity analyses, while analyses of general cognitive ability were less so. Conclusion We find some evidence of a causal effect of smoking on lower educational attainment, but not cognitive ability. Triangulation of evidence across observational and MR methods is a strength, but the genetic variants associated with smoking initiation may be pleiotropic, suggesting caution in interpreting these results. The nature of this pleiotropy warrants further study.

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Educational associations with missed GP appointments for patients under 35 years old: administrative data linkage study

BMC Medicine ◽

10.1186/s12916-021-02100-7 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Ross McQueenie ◽

David A. Ellis ◽

Michael Fleming ◽

Philip Wilson ◽

Andrea E. Williamson

Keyword(s):

Health Care ◽

Educational Attainment ◽

Representative Sample ◽

Public Services ◽

Negative Binomial ◽

Research Policy ◽

School Attendance ◽

Future Research ◽

Increased Risk ◽

Lower Educational Attainment

Abstract Background There is an evidence gap about whether levels of engagement with public services such as schools and health care affect people across the lifespan. Data on missed patient appointments from a nationally representative sample of Scottish general practices (GP) (2013–2016) were probabilistically linked to secondary school pupil data. We tested whether school attendance, exclusions (2007–2011) or lower educational attainment (2007–2016) was associated with an increased risk of missing general practice appointments. Methods School attendance data were classified into quartiles of possible days attended for years we had data. School exclusions were derived as a categorical variable of ‘ever excluded’. Attainment data were categorised via the Scottish Credit and Qualifications Framework (SCQF) level 3 or 6; a cumulative measure of attainment on leaving school. The associations between school attendance, exclusions and attainment and risk of missing medical appointments were investigated using negative binomial models, offset by number of GP appointments made and controlling for potential confounders. Results 112,534 patients (all aged under 35) had GP appointment and retrospective school attendance and exclusion data, and a subset of 66,967 also had attainment data available. Patients who had lower attendance, had been excluded from school or had lower educational attainment had an increased risk of missing GP appointments (all rate ratios > 1.40). Conclusions This study provides the first evidence from a population-representative sample in a high-income country that increased numbers of missed appointments in health care are associated with reduced school attendance, higher levels of school exclusion and lower educational attainment. Insights into the epidemiology of missingness across public services can support future research, policy and practice that aim to improve healthcare, health outcomes and engagement in services.

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Precise or Imprecise Probabilities? Evidence from Survey Response Related to Late-onset Dementia

Journal of the European Economic Association ◽

10.1093/jeea/jvab023 ◽

2021 ◽

Author(s):

Pamela Giustinelli ◽

Charles F Manski ◽

Francesca Molinari

Keyword(s):

Risk Perceptions ◽

Late Onset ◽

Imprecise Probabilities ◽

Imprecise Probability ◽

Term Care ◽

Older Americans ◽

Interval Probability ◽

Dementia Risk ◽

Two Measures ◽

Late Onset Dementia

Abstract We elicit numerical expectations for late-onset dementia and long-term care (LTC) outcomes in the Health and Retirement Study. We provide the first empirical evidence on dementia-risk perceptions among dementia-free older Americans and establish important patterns regarding imprecision of subjective probabilities. Our elicitation distinguishes between precise and imprecise probabilities, while accounting for rounding of reports. Imprecise-probability respondents quantify imprecision using probability intervals. Nearly half of respondents hold imprecise dementia and LTC probabilities, while almost a third of precise-probability respondents round their reports. These proportions decrease substantially when LTC expectations are conditioned on hypothetical knowledge of the dementia state. Among rounding and imprecise-probability respondents, our elicitation yields two measures: an initial rounded or approximated response and a post-probe response, which we interpret as the respondent's true point or interval probability. We study the mapping between the two measures and find that respondents initially tend to over-report small probabilities and under-report large probabilities. Using a specific framework for study of LTC insurance choice with uncertain dementia state, we illustrate the dangers of ignoring imprecise or rounded probabilities for modelling and prediction of insurance demand.

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Association of late‐onset dementia risk scores and Alzheimer’s disease pathology status in preclinical older adults

Alzheimer s & Dementia ◽

10.1002/alz.046448 ◽

2020 ◽

Vol 16 (S6) ◽

Author(s):

Chinedu T. Udeh‐Momoh ◽

Bang Zheng ◽

Geraint J. Price ◽

Tam J. Watermeyer ◽

Celeste A. Jager ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Older Adults ◽

Alzheimer's Disease ◽

Late Onset ◽

Risk Scores ◽

Dementia Risk ◽

Late Onset Dementia

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Does Smoking Cause Lower Educational Attainment and General Cognitive Ability? Triangulation of causal evidence using multiple study designs

10.1101/19009365 ◽

2019 ◽

Author(s):

Suzanne H. Gage ◽

Hannah Sallis ◽

Glenda Lassi ◽

Robyn Wootton ◽

Claire Mokrysz ◽

...

Keyword(s):

Cohort Study ◽

Educational Attainment ◽

Cognitive Ability ◽

Mendelian Randomization ◽

Causal Effect ◽

Smoking Initiation ◽

Sensitivity Analyses ◽

Genome Wide Association Studies ◽

Summary Statistics ◽

Lower Educational Attainment

AbstractObjectivesObservational epidemiological studies have found associations between smoking and both poorer cognitive ability and lower educational attainment; however, evaluating causality is more challenging. We used two complementary methods to attempt to ascertain whether smoking causes poorer cognitive ability and lower educational attainment.DesignA cohort study (Study One) and a two-sample Mendelian randomization study using publicly-available summary statistics (Study Two).SettingThe Avon Longitudinal Study of Parents and Children (ALSPAC), a birth-cohort study based in Bristol, United Kingdom, and general population samples from published genome-wide association studies (GWAS).ParticipantsUp to 12,004 young people in ALSPAC (complete case analysis N = 2,107) (Study One and Study Two), and summary statistics from three previously published GWAS (not individual-level data) (Study Two).Main outcome measuresCognitive ability at age 15 (assessed via the Wechsler Abbreviated Scale of Intelligence) and educational attainment at age 16 (assessed via school records) (Study One), and educational attainment (measured as years in education) and fluid intelligence from previously published GWAS (Study Two).ResultsIn Study One, heaviness of smoking at age 15 was associated with lower cognitive ability at age 15 and lower educational attainment at age 16. Adjustment for potential confounders and earlier cognitive ability or educational attainment attenuated findings although evidence of an association remained (e.g., fully adjusted cognitive ability beta - 0.736, 95% CI −1.238 to −0.233, P = 0.004; fully adjusted educational attainment beta −1.254, 95% CI −1.597 to −0.911, P < 0.001). Comparable results were found in sensitivity analyses of multiply imputed data. In Study Two, two-sample Mendelian randomization indicated that both smoking initiation and lifetime smoking lower educational attainment and cognitive ability (e.g., smoking initiation to educational attainment inverse-variance weighted MR beta −0.197, 95% CI −0.223, −0.171, P = 1.78 × 10−49). Educational attainment results were robust to various sensitivity analyses, while cognition analyses were less so.ConclusionsOur results provide evidence consistent with a causal effect of smoking on lower educational attainment, although were less consistent for cognitive ability. The triangulation of evidence from observational and Mendelian randomisation methods is an important strength for causal inference.Summary boxesWhat is already known on this topicAssociations are seen between smoking and both educational attainment and cognition. These is some evidence that educational attainment might causally influence smoking, but causality in the opposite direction has not been assessed.What this study addsUsing multiple methodologies, we found evidence consistent with a causal effect of smoking on lower educational attainment. An exploration of potential mechanisms could inform the development of interventions to mitigate this risk.

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Genetic propensity for obesity, socioeconomic position, and trajectories of body mass index in older adults

Scientific Reports ◽

10.1038/s41598-021-99332-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kristiane Tommerup ◽

Olesya Ajnakina ◽

Andrew Steptoe

Keyword(s):

Body Mass Index ◽

Educational Attainment ◽

Body Mass ◽

Socioeconomic Position ◽

Rate Of Change ◽

Older Adulthood ◽

Social Positioning ◽

Bmi Trajectories ◽

Baseline Bmi ◽

Lower Educational Attainment

AbstractIdentifying how socioeconomic positioning and genetic factors interact in the development of obesity is imperative for population-level obesity prevention strategies. The current study investigated whether social positioning, either independently or through interaction with a polygenic score for Body Mass Index (BMI-PGS), influences BMI trajectories across older adulthood. Data were analysed from 7,183 individuals from the English Longitudinal Study of Aging (ELSA). Interactions between the BMI-PGS and; lower educational attainment, self-perceived social status (SSS), and income, on BMI trajectories over 12 years across older adulthood were investigated through linear mixed effects models. Lower educational attainment, SSS and income were each associated with a higher baseline BMI for women, but not for men. There were interaction effects between BMI-PGS and social positioning such that men aged > 65 with a lower educational attainment (β = 0.62; 95%CI 0.00 – 1.24, p < 0.05), men aged ≤ 65 of a lower income (β = − 0.72, 95%CI − 1.21 - − 0.23, p < 0.01) and women aged ≤ 65 of lower SSS (β = − 1.41; 95%CI − 2.46 – 0.36, p < 0.01) showed stronger associations between the BMI-PGS and baseline BMI. There were few associations between markers of socioeconomic position and rate of change in BMI over the follow-up period. In sum, lower socioeconomic positioning showed adverse associations with women’s BMI in older adulthood. Moreover, the expression of the BMI-PGS, or extent to which it translates to a higher BMI, was subtly influenced by socioeconomic standing in both women and in men.

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Influence of childhood socioeconomic position and ability on mid-life cognitive function: evidence from three British birth cohorts

Journal of Epidemiology & Community Health ◽

10.1136/jech-2020-215637 ◽

2021 ◽

pp. jech-2020-215637

Author(s):

Eoin McElroy ◽

Marcus Richards ◽

Emla Fitzsimons ◽

Gabriella Conti ◽

George B Ploubidis ◽

...

Keyword(s):

Cognitive Function ◽

Educational Attainment ◽

Cognitive Ability ◽

Socioeconomic Position ◽

Structural Equation ◽

Occupational Status ◽

Birth Cohorts ◽

Modifiable Factors ◽

British Cohort Study ◽

Childhood Cognitive Ability

BackgroundChildhood socioeconomic position (SEP) is robustly associated with cognitive function later in life. However, it is unclear whether this reflects a direct relationship, or an indirect association via modifiable factors such as educational attainment and occupation. We sought to clarify these associations using retrospectively harmonised data from three ongoing British birth cohorts.MethodsWe analysed data from the 1946 National Survey of Health and Development (n=2283), the 1958 National Child Development Study (n=9385) and the 1970 British Cohort Study (n=7631). Retrospective harmonisation was used to derive equivalent indicators of cognition, SEP, education and occupation across the three cohorts. Structural equation modelling was used to examine the association between childhood SEP and mid-life cognitive function, via childhood cognitive ability, educational attainment and mid-life occupation.ResultsAcross all three cohorts, no direct pathways were observed between childhood SEP and mid-life cognitive function. Rather, this association was indirect via the three temporally ordered mediators. In addition, the direct pathway between childhood cognition and adult cognitive function was weaker in the two younger studies.ConclusionsAcross three British birth cohorts, we found that the association between early life SEP and mid-life cognitive function was fully mediated by childhood cognitive ability, educational attainment and occupational status. Furthermore, the association between early cognitive ability and mid-life cognitive function has decreased in younger generations. Therefore, cognitive function in adulthood may be influenced by modifiable factors and societal change.

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Cognitive ability in young adulthood predicts risk of early-onset dementia in Finnish men

Neurology ◽

10.1212/wnl.0000000000005757 ◽

2018 ◽

Vol 91 (2) ◽

pp. e171-e179 ◽

Cited By ~ 5

Author(s):

Ville Rantalainen ◽

Jari Lahti ◽

Markus Henriksson ◽

Eero Kajantie ◽

Johan G. Eriksson ◽

...

Keyword(s):

Cognitive Ability ◽

Early Onset ◽

Late Onset ◽

Disease Diagnosis ◽

Intellectual Ability ◽

Birth Cohort Study ◽

Ability Test ◽

Early Onset Dementia ◽

Dementia Risk ◽

Organic Dementia

ObjectiveTo test if the Finnish Defence Forces Basic Intellectual Ability Test scores at 20.1 years predicted risk of organic dementia or Alzheimer disease (AD).MethodsDementia was defined as inpatient or outpatient diagnosis of organic dementia or AD risk derived from Hospital Discharge or Causes of Death Registers in 2,785 men from the Helsinki Birth Cohort Study, divided based on age at first diagnosis into early onset (<65 years) or late onset (≥65 years). The Finnish Defence Forces Basic Intellectual Ability Test comprises verbal, arithmetic, and visuospatial subtests and a total score (scores transformed into a mean of 100 and SD of 15). We used Cox proportional hazard models and adjusted for age at testing, childhood socioeconomic status, mother's age at delivery, parity, participant's birthweight, education, and stroke or coronary heart disease diagnosis.ResultsLower cognitive ability total and verbal ability (hazard ratio [HR] per 1 SD disadvantage >1.69, 95% confidence interval [CI] 1.01–2.63) scores predicted higher early-onset any dementia risk across the statistical models; arithmetic and visuospatial ability scores were similarly associated with early-onset any dementia risk, but these associations weakened after covariate adjustments (HR per 1 SD disadvantage >1.57, 95% CI 0.96–2.57). All associations were rendered nonsignificant when we adjusted for participant's education. Cognitive ability did not predict late-onset dementia risk.ConclusionThese findings reinforce previous suggestions that lower cognitive ability in early life is a risk factor for early-onset dementia.

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