Where you live affects your risk of dementia.
Socioeconomic status is a key indicator of health outcomes, including access to and quality of health care. In 4,656 adults across metropolitan, regional and rural Australia, new research from the Healthy Brain Project has shown that those living in more deprived areas have poorer memory and a greater risk of developing dementia.
Health inequalities in the risk of dementia
Dementia is the second leading cause of death in Australia. Our rapidly aging population means that without a substantial medical breakthrough, the number of people with dementia in Australia is set to double from 487,600 in 2022 to 1.1 million by 2058.
There has been a concerted effort to understand and identify risk factors for dementia. These include risk factors that we cannot change (like age or genetics) and others that are more modifiable (like diet or physical activity).
However, dementia and its risk factors do not affect all communities equally. Educational, racial/ethnic and geographic disparities can influence who develops dementia, including in Australia and the United States.
Our study assessed geographic inequality at the neighborhood level. We measured neighborhood-level socioeconomic status by matching participants’ postcodes with the Australian Bureau of Statistics’ Relative Socioeconomic Advantage and Disadvantage Index.
This index incorporates information related to several factors, such as average household income, education, unemployment rates, job skills, disability, vehicle ownership, internet connection, family structures and housing conditions. Lower scores suggest greater socio-economic disadvantage.
What did we find?
We found that lower socioeconomic status at the neighborhood level was associated with poorer memory performance and higher risk of dementia.
This was particularly the case for the elderly (55 years and over). Older people living in neighborhoods with lower socioeconomic status had poorer memory and a higher risk of dementia.
This is in line with a US study that found adults living in the bottom 20% of inner city neighborhoods had smaller brains.
What do these findings mean?
The first thing to note is that this was an observational study, which involves following a group of people and studying how potential risk factors relate to the risk of dementia. The results do not mean that living in a more disadvantaged area leads to memory loss or dementia.
The results only indicate that there is a relationship or association between neighborhood disadvantage and dementia risk.
Second, socioeconomic status at the neighborhood level measures many complexities and nuances of where people live.
This captures a range of information that may influence health outcomes and disease risk. Some of these factors include the prevalence of crime and safety, local resources including access to health care and education, opportunities and space for physical activity and recreation, social unrest, access to greenery, as well as air and noise pollution.
These economic, psychosocial and environmental factors can not only influence health outcomes, but also our behavior. For example, a lack of green spaces or community sports facilities can discourage physical activity, which is a known risk factor for poor heart and brain health.
Similarly, libraries and recreation centers provide important avenues for social engagement and mental development, the absence of which is also a risk factor for dementia.
Additionally, due to affordability, people from lower socio-economic backgrounds may also live in areas with fewer services that support a healthy lifestyle. They are also more likely to have poorer health outcomes due to entrenched disadvantage and low health literacy.
This cyclical nature of inequality may also explain why we observed a higher risk of dementia among people from lower socio-economic backgrounds.
It will be critical for future work to understand whether neighborhood socioeconomic status influences memory decline over time and actual diagnosis of dementia.
What should be done?
Targeting the socio-economic status of the neighborhood will require huge investments and collective efforts at the local, state and national level. As a starting point, increasing the availability and accessibility of green spaces and community facilities, such as recreation and sports clubs, in every postcode will provide greater opportunities for healthy and healthy lifestyles. active into old age.
At the individual level, positive health behaviors have been identified that can help prevent or delay memory loss and dementia risk. These include a balanced diet, learning new skills or languages, regular physical activity, maintaining social connections, and getting a good night’s sleep.
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