Midlife socioeconomic position and old-age dementia mortality: A large prospective register-based study from Finland
Open accessAbstract
OBJECTIVES: To assess the association between multiple indicators of socioeconomic position and dementia-related death, and to estimate the contribution of dementia to socioeconomic differences in overall mortality at older ages. DESIGN: Prospective population-based register study. SETTING: Finland. PARTICIPANTS: 11% random sample of the population aged 70-87 years resident in Finland at the end of year 2000 (n=54 964). MAIN OUTCOME MEASURE: Incidence rates, Kaplan-Meier survival probabilities and Cox regression HRs of dementia mortality in 2001-2016 by midlife education, occupational social class and household income measured at ages 53-57 years. RESULTS: During the 528 387 person-years at risk, 11 395 individuals died from dementia (215.7 per 10 000 person-years). Lower midlife education, occupational social class and household income were associated with higher dementia mortality, and the differences persisted to the oldest old ages. Compared with mortality from all other causes, however, the socioeconomic differences emerged later. Dementia accounted for 28% of the difference between low and high education groups in overall mortality at age 70+ years, and for 21% of the difference between lowest and highest household income quintiles. All indicators of socioeconomic position were independently associated with dementia mortality, low household income being the strongest independent predictor (HR=1.24, 95% CI 1.16 to 1.32), followed by basic education (HR=1.14, 1.06 to 1.23). Manual occupational social class was related to a 6% higher hazard (HR=1.06, 1.01 to 1.11) compared with non-manual social class. Adjustment for midlife economic activity, baseline marital status and chronic health conditions attenuated the excess hazard of low midlife household income, although significant effects remained. CONCLUSION: Several indicators of socioeconomic position predict dementia mortality independently and socioeconomic inequalities persist into the oldest old ages. The results demonstrate that dementia is among the most important contributors to socioeconomic inequalities in overall mortality at older ages.
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Existing research examines the impact of few social, demographic or geographic factors in mortality risk among people living with dementia.
“Existing research examines the impact of few social, demographic or geographic factors in mortality risk among PLWD [1,2,40].”
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 [2]
There are inequalities in mortality for people living with dementia by various socio-economic and geographic factors.
“There are inequalities in mortality for people living with dementia (PLWD) by various socio-economic and geographic factors [1,2].”
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 [2]
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Dementia prevention, intervention, and care
Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S. G., Huntley, J., Ames, D., Ballard, C., Banerjee, S., Burns, A., Cohen-Mansfield, J., et al. (2017) · The Lancet · doi:10.1016/s0140-6736(17)31363-6 · Cited by 6,072 · see citing works
What is cognitive reserve? Theory and research application of the reserve concept
STERN, Y. (2002) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617702813248 · Cited by 3,951 · see citing works
Baumgart, M., Snyder, H. M., Carrillo, M. C., Fazio, S., Kim, H., & Johns, H. (2015) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2015.05.016 · Cited by 1,660 · see citing works
Geyer, S., Hemström, Ö., Peter, R., & Vågerö, D. H. (2006) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2005.041319 · Cited by 684 · see citing works
Marmot, M. G., & Shipley, M. J. (1996) · BMJ · doi:10.1136/bmj.313.7066.1177 · Cited by 437 · see citing works
Huisman, M. A., Kunst, A. E., Bopp, M., Borgan, J., Borrell, C., Costa, G., Deboosere, P., Gadeyne, S., Glickman, M., & Marinacci, C. (2005) · The Lancet · doi:10.1016/s0140-6736(05)70273-7 · Cited by 412 · see citing works
Huisman, M. A., Kunst, A. E., Bopp, M., Borgan, J.-K., Borrell, C., Costa, G., Deboosere, P., Gadeyne, S., Glickman, M., Marinacci, C., et al. (2005) · The Lancet · doi:10.1016/s0140-6736(05)17867-2 · Cited by 409 · see citing works
Education, the brain and dementia: neuroprotection or compensation?
Brayne, C., Ince, P. G., Keage, H. A. D., McKeith, I. G., Matthews, F. E., Polvikoski, T. M., & Sulkava, R. O. (2010) · Brain · doi:10.1093/brain/awq185 · Cited by 392 · see citing works
Midlife psychological stress and risk of dementia: a 35-year longitudinal population study
Johansson, L. H., Guo, X., Wærn, M., Östling, S., Gustafson, D., Bengtsson, C., & Skoog, I. G. (2010) · Brain · doi:10.1093/brain/awq116 · Cited by 291 · see citing works
Stern, Y., Tang, M. X., Denaro, J., & Mayeux, R. (1995) · Annals of Neurology · doi:10.1002/ana.410370508 · Cited by 252 · see citing works
Lamarca, R., Alonso, J., Gomez, G., & Muñoz, Á. (1998) · The Journals of Gerontology Series A · doi:10.1093/gerona/53a.5.m337 · Cited by 213 · see citing works
Karp, A., Andel, R., Parker, M. G., Wang, H., Winblad, B. G., & Fratiglioni, L. (2009) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e318190b691 · Cited by 165 · see citing works
Wealth and mortality at older ages: a prospective cohort study
Demakakos, P., Biddulph, J. P., Bobák, M., & Marmot, M. G. (2015) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2015-206173 · Cited by 155 · see citing works
Russ, T. C., Stamatakis, E., Hamer, M., Starr, J. M., Kivimäki, M., & Batty, G. D. (2013) · British Journal of Psychiatry · doi:10.1192/bjp.bp.112.119479 · Cited by 152 · see citing works
Is Complexity of Work Associated with Risk of Dementia?: The Canadian Study of Health and Aging
Kröger, E., Andel, R., Lindsay, J., Benounissa, Z., Verreault, R., & Laurin, D. (2008) · American Journal of Epidemiology · doi:10.1093/aje/kwm382 · Cited by 151 · see citing works
Validity of dementia and Alzheimer's disease diagnoses in Finnish national registers
Solomon, A., Ngandu, T., Soininen, H. S., Hallikainen, M., Kivipelto, M., & Laatikainen, T. K. (2013) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2013.03.004 · Cited by 139 · see citing works
Huisman, M. A., Read, S., Towriss, C. A., Deeg, D. J. H., & Grundy, E. M. D. (2013) · Epidemiologic Reviews · doi:10.1093/epirev/mxs010 · Cited by 117 · see citing works
Systematic review of the effect of education on survival in Alzheimer's disease
Paradise, M., Cooper, C., & Livingston, G. (2008) · International Psychogeriatrics · doi:10.1017/s1041610208008053 · Cited by 114 · see citing works
Mortality by indicators of socioeconomic status among the finnish elderly
Martelin, T. P. (1994) · Social Science & Medicine · doi:10.1016/0277-9536(94)90190-2 · Cited by 112 · see citing works
Ptacek, S. G., Kåreholt, I., Čermáková, P., Rizzuto, D., Religa, D., & Eriksdotter, M. (2016) · Journal of the American Geriatrics Society · doi:10.1111/jgs.14421 · Cited by 91 · see citing works
Rognerud, M. A., & Zahl, P. (2005) · European Journal of Public Health · doi:10.1093/eurpub/cki070 · Cited by 78 · see citing works
Martikainen, P., Blomgren, J., & Valkonen, T. (2007) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2006.049940 · Cited by 64 · see citing works
Self-citationIncome in midlife and dementia related mortality over three decades: A Norwegian prospective study
Strand, B. H., Skirbekk, V., Rosness, T. A., Engedal, K., & Bjertness, E. (2015) · eNeurologicalSci · doi:10.1016/j.ensci.2015.09.002 · Cited by 24 · see citing works
Is socioeconomic status a predictor of mortality in nonagenarians? The vitality 90+ study
Enroth, L., Raitanen, J. A., Hervonen, A., Nosraty, L., & Jylhä, M. K. (2014) · Age and Ageing · doi:10.1093/ageing/afu092 · Cited by 24 · see citing works
Age, education and dementia related deaths. The Norwegian Counties Study and The Cohort of Norway
Strand, B. H., Langballe, E. M., Rosness, T. A., Bergem, A. L. M., Engedal, K., Nafstad, P. H. J., Tell, G. S., Ormstad, H., Tambs, K., & Bjertness, E. (2014) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2014.07.009 · Cited by 21 · see citing works
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Watson, J., Darlington-Pollock, F., Green, M., Giebel, C., & Akpan, A. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182413405 · Cited by 21 · see citing works
- Authors
- Korhonen, K., Einiö, E., Leinonen, T., Tarkiainen, L., & Martikainen, P.
- Affiliations
- University of Helsinki (FI)
- Finnish Institute of Occupational Health (FI)
- Corresponding author
- Korhonen, Kaarina
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2020-01
- Volume
- 10
- Issue
- 1
- Pages
- e033234
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC6955538
- OpenAlex
- W2998876495
- Cited by
- 43
- References
- 26
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 9 · 2023: 6 · 2022: 6 · 2021: 8 · 2020: 1
- FWCI
- 2.91
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMJ Open (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- London School of Economics and Political Science Research Online (London School of Economics and Political Science) (acceptedVersion)
- London School of Economics and Political Science Theses Online (London School of Economics and Political Science) (acceptedVersion)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Työväentutkimus Vuosikirja (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- European Commission (667661)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Sociology and Political Science › Intergenerational and Educational Inequality Studies
- Keywords
- dementia mortality, socioeconomic position, household income, occupational class, blue-collar workers, socioeconomic inequalities in mortality, oldest old, chronic disease, marital status
- MeSH terms
- Age Factors, Aged, Aged, 80 and over, Alzheimer Disease, Female, Finland, Humans, Male, Prospective Studies, Registries, Risk Factors, Socioeconomic Factors, Survival Rate, Age Distribution, Health Status Disparities
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