Variation in Population Attributable Fraction of Dementia Associated with Potentially Modifiable Risk Factors by Race and Ethnicity in the US

Mark Lee, Eric Whitsel, Christy Avery, Timothy M. Hughes, Michael E. Griswold, Sanaz Sedaghat, Rebecca F. Gottesman, Thomas H. Mosley, Gerardo Heiss, Pamela L. Lutsey

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Importance: Identifying modifiable risk factors that are associated with dementia burden across racial and ethnic groups in the population can yield insights into the potential effectiveness of interventions in preventing dementia and reducing disparities. Objective: To calculate the population attributable fraction (PAF) of dementia associated with 12 established modifiable risk factors for all US adults, as well as separately by race and ethnicity. Design, Setting, and Participants: This cross-sectional study used survey data from nationally representative samples of US adults. PAFs were calculated using relative risks and prevalence estimates for 12 risk factors. Relative risks were taken from meta-analyses, as reported in a 2020 systematic review. Prevalence estimates for risk factors were derived from nationally representative cross-sectional survey data collected between 2011 and 2018. Combined PAFs were adjusted for risk factor communality using weights derived from the Atherosclerosis Risk in Communities (ARIC) study (1987-2018). Analyses were conducted May through October 2021. Exposures: Low education, hearing loss, traumatic brain injury, hypertension, excessive alcohol consumption, obesity, smoking, depression, social isolation, physical inactivity, diabetes, and air pollution. Main Outcomes and Measures: PAF for each dementia risk factor, a combined PAF, and the decrease in the number of prevalent dementia cases in 2020 that would be expected given a 15% proportional decrease in each exposure. Results: Among all US adults, an estimated 41.0% (95% CI, 22.7%-55.9%) of dementia cases were attributable to 12 risk factors. A 15% proportional decrease in each risk factor would reduce dementia prevalence in the population by an estimated 7.3% (95% CI, 3.7%-10.9%). The estimated PAF was greater for Black and Hispanic than it was for White and Asian individuals. The greatest attributable fraction of dementia cases was observed for hypertension (PAF, 20.2%; 95% CI, 6.3%-34.4%), obesity (PAF, 20.9%; 95% CI, 13.0%-28.8%), and physical inactivity (PAF, 20.1%; 95% CI, 9.1%-29.6%). These factors were also highest within each racial and ethnic group, although the proportions varied. Conclusions and Relevance: A large fraction of dementia cases in the US were associated with potentially modifiable risk factors, especially for Black and Hispanic individuals. Targeting and reducing these risk factors may curb the projected rise in dementia cases over the next several decades.

Original languageEnglish (US)
Pages (from-to)E2219672
JournalJAMA Network Open
Issue number7
StatePublished - Jul 6 2022

Bibliographical note

Funding Information:
Funding/Support: The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, HHSN268201700005I). Neurocognitive data is collected by grants No. U01 2U01HL096812, 2U01HL096814, 2U01HL096899, 2U01HL096902, 2U01HL096917 from the NIH (National Heart, Lung, and Blood Institute, National Institute of Neurological Disorders and Stroke, National Institute on Aging, and National Institute on Deafness and Other Communication Disorders) and with previous brain magnetic resonance imaging examinations funded by R01-HL70825 from the NHLBI. Dr Lutsey was partially supported by NIH grant No. K24 HL159246.

Funding Information:
Conflict of Interest Disclosures: Dr Hughes reported receiving grants funding from the National Institutes of Health (NIH) during the conduct of the study. Dr Griswold reported receiving grants from the NIH during the conduct of the study. Dr Gottesman reported receiving research support from the National Institute of Neurological Disorders and Stroke Intramural Research Program; she reported previous service as an associate editor with the American Academy of Neurology and Neurology outside the submitted work. Dr Mosley reported receiving grants from NIH during the conduct of the study. Dr Lutsey reported grants from NIH during the conduct of the study and grants from NIH outside the submitted work. No other disclosures were reported.

Publisher Copyright:
© 2022 American Institute of Physics Inc.. All rights reserved.

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


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