The association between sociodemographic characteristics and dementia in patients with atrial fibrillation
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ORIGINAL ARTICLE
The association between sociodemographic characteristics and dementia in patients with atrial fibrillation Per Wändell1 · Axel C. Carlsson1 · Xinjun Li2 · Danijela Gasevic3,4 · Jan Sundquist2,5,6 · Kristina Sundquist2,5,6 Received: 5 November 2019 / Accepted: 11 December 2019 © The Author(s) 2020
Abstract Objectives Association between socio-demographic factors and dementia risk is studied in general but not for atrial fibrillation (AF) patients. Methods We studied AF patients ≥ 45 years in Sweden 1998–2012 (n = 537,513) using the Total Population Register for socio-demographic factors, the Swedish Cause of Death Register, and the National Patient Register (NPR) for incident dementia. Cox regression with hazard ratios (HR) and 95% confidence intervals (CI) was used for the association between exposure and outcome, adjusting for age and comorbidities. Results Totally 30,332 patients (5.6%) were diagnosed with dementia during the follow-up (mean 5.4 years). Of these, 14,097 were men (4.9%) and 16,235 were women (6.5%). Lower educational levels (reference: highest level) were associated with increased dementia, HRs (95% CI) for basic school for men 1.23 (1.18–1.29) and women 1.36 (1.30–1.42), and middle-level school for men 1.17 (1.11–1.22) and women 1.28 (1.22–1.34). Divorced men and women (reference: married) showed increased risk of dementia, HR 1.07 (1.01–1.13) and 1.12 (1.06–1.18), respectively, while widowed men showed lower risk, HR 0.84 (0.80–0.88). High deprivation neighborhood socio-economic status (NSES; reference: medium level) was associated with increased dementia in men, HR 1.11 (1.05–1.17), and low deprivation neighborhood socio-economic status (NSES) with increased dementia in men and women, HR 1.12 (1.06–1.18) and 1.18 (1.12–1.24), respectively. Conclusions Some results were expected, i.e. association between lower educational level and dementia. The higher risk of dementia in low deprivation NSES-areas could be due to a higher awareness about dementia, and subsequent earlier diagnosis and treatment of dementia. Keywords Atrial fibrillation · Dementia · Gender · Socio-economic factors · Marital status
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40520-019-01449-3) contains supplementary material, which is available to authorized users. * Per Wändell [email protected] 1
Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Alfred Nobels Allé 12, 141 83 Huddinge, Sweden
2
Center for Primary Health Care Research, Lund University, Malmö, Sweden
3
Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
Dementia is one of the greatest current global health challenges with substantial physical, social and economic impact on the lives of people living with the condition as well as on their family and society as a whole [1]. In 2015, 4
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