Do Socioeconomic Disparities Affect the Incidence of Dementia?

Summary and Comment |
February 4, 2014

Do Socioeconomic Disparities Affect the Incidence of Dementia?

  1. Jaime Toro, MD

Differences in socioeconomic status may contribute to higher rates of dementia in black compared with white older individuals.

  1. Jaime Toro, MD

Compared with white Americans, black Americans have a higher incidence of chronic disease, a shorter life expectancy, and worse health outcomes. Socioeconomic status may contribute to the higher rate of dementia seen in black compared with white older people. Socioeconomic disadvantages experienced by older black people lead to fewer educational opportunities, which may explain the increased rate of cognitive decline. Epidemiological studies have shown that education and literacy may be protective factors against cognitive decline. To examine this issue, researchers conducted a longitudinal study involving 2457 people (mean age, 73.6 years) who were dementia-free at baseline. Participants reported demographics and socioeconomic measures including income, perceived financial adequacy, and education level attained. Participants also underwent a literacy test.

During 12 years of follow-up, 449 participants (18.3%) developed dementia; 38% of these were receiving medication for dementia, 62% had a hospital diagnosis, and 51% met criteria for change in cognitive status. Black participants were more likely than whites to develop dementia (20.7% vs. 16.6%). This difference was attenuated slightly after adjustment for differences in demographics, apolipoprotein ℇ e4 status, comorbidities, and lifestyle factors. By contrast, the difference was no longer significant after adjustment for socioeconomic variables.


This well-conducted study shows that low socioeconomic status is associated with worse physical and cognitive health, which increases the risk for dementia. In other studies, not only black but also Hispanic Americans have a significantly elevated risk for Alzheimer disease. Although other factors involved in low socioeconomic status may be associated with cognitive impairment, fewer years of education and less literacy may contribute to cognitive decline (Am J Geriatr Psychiatr 2005; 13:968). In future studies, other environmental factors that work through epigenetic mechanisms should be analyzed to further elucidate these racial differences.

Editor Disclosures at Time of Publication

  • Disclosures for Jaime Toro, MD at time of publication Editorial boards Multiple Sclerosis and Related Disorders


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