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BMC Geriatrics
Published in: BMC Geriatrics 1/2024

Open Access 01-12-2024 | Dementia | Research

Comorbidity and household income as mediators of gender inequalities in dementia risk: a real-world data population study

Authors: Uxue Zubiagirre, Oliver Ibarrondo, Igor Larrañaga, Myriam Soto-Gordoa, Lorea Mar-Barrutia, Javier Mar

Published in: BMC Geriatrics | Issue 1/2024

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Abstract

Background

Low household income (HI), comorbidities and female sex are associated with an increased risk of dementia. The aim of this study was to measure the mediating effect of comorbidity and HI on the excess risk due to gender in relation to the incidence and prevalence of dementia in the general population.

Methods

A retrospective and observational study using real-world data analysed all people over 60 who were registered with the Basque Health Service in Gipuzkoa. The study measured HI level, the Charlson comorbidity index (CCI), age and sex. The prevalence and incidence of dementia were analysed using logistic regression and Poisson regression models, respectively, adjusted by HI, sex, comorbidity and age. We estimated the combined mediation effect of HI and comorbidity on the prevalence of dementia associated with gender.

Results

Of the 221,777 individuals, 3.85% (8,549) had a diagnosis of dementia as of 31 December 2021. Classification by the CCI showed a gradient with 2.90% in CCI 0–1, 10.60% in CCI 2–3 and 18.01% in CCI > 3. Both low HI and gender were associated with a higher crude prevalence of dementia. However, in the CCI-adjusted model, women had an increased risk of dementia, while HI was no longer statistically significant. The incidence analysis produced similar results, although HI was not significant in any model. The CCI was significantly higher for men and for people with low HI. The mediation was statistically significant, and the CCI and HI explained 79% of the gender effect.

Conclusions

Comorbidity and low HI act as mediators in the increased risk of dementia associated with female sex. Given the difference in the prevalence of comorbidities by HI, individual interventions to control comorbidities could not only prevent dementia but also reduce inequalities, as the risk is greater in the most disadvantaged population.
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Metadata
Title
Comorbidity and household income as mediators of gender inequalities in dementia risk: a real-world data population study
Authors
Uxue Zubiagirre
Oliver Ibarrondo
Igor Larrañaga
Myriam Soto-Gordoa
Lorea Mar-Barrutia
Javier Mar
Publication date
01-12-2024
Publisher
BioMed Central
Keywords
Dementia
Dementia
Published in
BMC Geriatrics / Issue 1/2024
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-024-04770-3

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