Geographical variation in dementia: Systematic review with meta-analysis
Open accessAbstract
BACKGROUND: Geographical variation in dementia prevalence and incidence may indicate important socio-environmental contributions to dementia aetiology. However, previous comparisons have been hampered by combining studies with different methodologies. This review systematically collates and synthesizes studies examining geographical variation in the prevalence and incidence of dementia based on comparisons of studies using identical methodologies. METHODS: Papers were identified by a comprehensive electronic search of relevant databases, scrutinising the reference sections of identified publications, contacting experts in the field and re-examining papers already known to us. Identified articles were independently reviewed against inclusion/exclusion criteria and considered according to geographical scale. Rural/urban comparisons were meta-analysed. RESULTS: Twelve thousand five hundred and eighty records were reviewed and 51 articles were included. Dementia prevalence and incidence varies at a number of scales from the national down to small areas, including some evidence of an effect of rural living [prevalence odds ratio (OR) = 1.11, 90% confidence interval (CI) 0.79-1.57; incidence OR = 1.20, 90% CI 0.84-1.71]. However, this association of rurality was stronger for Alzheimer disease, particularly when early life rural living was captured (prevalence OR = 2.22, 90% CI 1.19-4.16; incidence OR = 1.64, 90% CI 1.08-2.50). CONCLUSIONS: There is evidence of geographical variation in rates of dementia in affluent countries at a variety of geographical scales. Rural living is associated with an increased risk of Alzheimer disease, and there is a suggestion that early life rural living further increases this risk. However, the fact that few studies have been conducted in resource-poor countries limits conclusions.
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Inequalities in dementia and dementia outcomes have been illustrated across spatial contexts-including where somebody lives, the levels of deprivation in the area they live, and where their GP is based.
“Inequalities in dementia and dementia outcomes have been illustrated across spatial contexts—including where somebody lives, the levels of deprivation in the area they live, and where their GP is based [17,32,33].”
From The Impact of demographic, socio-economic and geographic factors on mortality risk among people living with dementia in England (2002–2016) (2021) · cites this paper as [32]
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- Authors
- Russ, T. C., Batty, G. D., Hearnshaw, G. F., Fenton, C., & Starr, J. M.
- Affiliations
- National Health Service Scotland (GB)
- University College London (GB)
- Venue
- International Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-07-13
- Volume
- 41
- Issue
- 4
- Pages
- 1012-1032
- ISSN
- 0300-5771 (ISSN-L)
- 1464-3685
- PMC
- PMC3429875
- OpenAlex
- W2136224870
- Cited by
- 191
- References
- 141
- Citations by year
- 2026: 6 · 2025: 17 · 2024: 21 · 2023: 20 · 2022: 19 · 2021: 18 · 2020: 14 · 2019: 11 · 2018: 12 · 2017: 12 · 2016: 12 · 2015: 9 · 2014: 12 · 2013: 6 · 2012: 2
- FWCI
- 1.25
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- International Journal of Epidemiology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
- UCL Discovery (University College London) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Wellcome Trust
- Biotechnology and Biological Sciences Research Council
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Keywords
- dementia, regional variation, dementia prevalence, dementia incidence, urban-rural differences, rurality, Alzheimer's disease, socio-environmental risk factors, small area variation
- MeSH terms
- Dementia, Geography, Humans, Incidence, Prevalence
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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