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75/100

✓ Peer-reviewed alzhub usefulness score 75 out of 100. Prevention and risk

Topic: Risk, prevention and care in population studies

Background Nine potentially modifiable risk factors (less childhood education, midlife hearing loss, hypertension, and obesity, and later-life smoking, depression, physical inactivity, social isolation, and diabetes) account for 35% of worldwide dementia, but most data to calculate these risk factors come from high-income countries only. We aimed to calculate population attributable fractions (PAFs) for dementia in selected low-income and middle-income countries (LMICs) to identify potential dementia prevention targets in these countries. Methods The study was an analysis of cross-sectional data obtained from the 10/66 Dementia Research surveys of representative populations in India, China, and six Latin America countries (Cuba, Dominican Republic, Mexico, Peru, Puerto Rico, and Venezuela), which used identical risk factor ascertainment methods in each country. Between 2004 and 2006 (and between 2007 and 2010 for Puerto Rico), all residents aged 65 years and older in predefined catchment areas were invited to participate in the survey. We used risk factor prevalence estimates from this 10/66 survey data, and relative risk estimates from previous meta-analyses, to calculate PAFs for each risk factor. To account for individuals having overlapping risk factors, we adjusted PAF for communality between risk factors, and used these values to calculate overall weighted PAFs for India, China, and the Latin American sample. Findings The overall weighted PAF for potentially modifiable risk factors for dementia was 39·5% (95% CI 37·5-41·6) in China (n=2162 participants), 41·2% (39·1-43·4) in India (n=2004), and 55·8% (54·9-56·7) in our Latin American sample (n=12 865). Five dementia risk factors were more prevalent in these LMICs than worldwide estimates, leading to higher PAFs for dementia: less childhood education (weighted PAF of 10·8% in China, 13·6% in India, and 10·9% in Latin America vs 7·5% worldwide), smoking (14·7%, 6·4%, and 5·7%, respectively, vs 5·5% worldwide), hypertension (6·4%, 4·0%, and 9·3%, vs 2·0%), obesity (5·6%, 2·9%, and 7·9%, vs 0·8%), and diabetes (1·6%, 1·7%, and 3·2%, vs 1·2%). Interpretation The dementia prevention potential in India, China, and this sample of Latin American countries is large, and greater than in high-income countries. Less education in early life, hypertension, hearing loss, obesity, and physical inactivity have particularly high PAFs and could be initial targets for dementia prevention strategies. Funding No funding.

Cite this study APA, Vancouver, BibTeX · download .bib or .ris

APA 7th

Mukadam, N., Sommerlad, A., Huntley, J., & Livingston, G. (2019). Population attributable fractions for risk factors for dementia in low-income and middle-income countries: an analysis using cross-sectional survey data. The Lancet. Global health. https://doi.org/10.1016/s2214-109x(19)30074-9

Vancouver

Mukadam N, Sommerlad A, Huntley J, Livingston G. Population attributable fractions for risk factors for dementia in low-income and middle-income countries: an analysis using cross-sectional survey data. The Lancet. Global health. 2019. doi:10.1016/s2214-109x(19)30074-9. PMID: 31000129.

BibTeX

@article{mukadam2019-31000129,
  author  = {Mukadam, N. and Sommerlad, A. and Huntley, J. and Livingston, G.},
  title   = {{Population attributable fractions for risk factors for dementia in low-income and middle-income countries: an analysis using cross-sectional survey data}},
  journal = {The Lancet. Global health},
  year    = {2019},
  doi     = {10.1016/s2214-109x(19)30074-9},
  pmid    = {31000129},
  url     = {https://doi.org/10.1016/s2214-109x(19)30074-9}
}

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Key findings

To account for individuals having overlapping risk factors, we adjusted PAF for communality between risk factors, and used these values to calculate overall weighted PAFs for India, China, and the Latin American sample.
Findings The overall weighted PAF for potentially modifiable risk factors for dementia was 39·5% (95% CI 37·5-41·6) in China (n=2162 participants), 41·2% (39·1-43·4) in India (n=2004), and 55·8% (54·9-56·7) in our Latin American sample (n=12 865).

Why it matters

This 2019 analysis of survey data from people aged 65 and older estimated that potentially modifiable risk factors account for 39·5% of dementia in its China sample, 41·2% in India and 55·8% in six Latin American countries, against 35% worldwide. Less childhood education, smoking, hypertension, obesity and diabetes were more common in these samples than worldwide, and the authors conclude that the potential for prevention there is large. These are calculated estimates that combine one-time surveys from 2004–2010 with risk figures from earlier meta-analyses; the study did not test whether changing any risk factor lowers dementia.

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Study details

Study designmeta-analysis
Participants2,162
Evidence strengthHigh

How this study scored 75/100

Published in a peer-reviewed journal, and it is a meta-analysis pooling many studies. Scored zero for effect reported because the record does not state it.

Component	Points	Why
Journal tier	7 / 10	Tier 3 — peer-reviewed journal (The Lancet. Global health)
Journal's citation record	2 / 4	The Lancet Global Health: journal h-index 219 (OpenAlex, 2026-10-29)
Study design	12 / 12	A meta-analysis pooling many studies
Strength of evidence	5 / 5	Rated “high” in our summary
Peer-review validation	10 / 10	Peer-reviewed. Published as an article in a named peer-reviewed journal.
How recent	2 / 5	2019 — within 10 year(s) of the newest study here
Sample size	3 / 4	2,162 participants
Effect reported	0 / 3	No effect size reported — scores zero (not stated in the record — scored 0)
Studied in people	3 / 3	Studied in people (participant count stated)
Randomised / blinded	0 / 2	A review of other studies — randomisation is not credited here
Times cited	6 / 7	Cited 416 times (OpenAlex, 2026-10-10)
Citations per year	4 / 5	46.2 citations a year over 9 year(s) since 2019
Impact for its field and year	5 / 6	Cited 27.9× the average for papers of its field and year (OpenAlex FWCI)
Cited by studies here	4 / 6	Cited by 34 other studies in this library
Still being cited	3 / 4	Cited 178 times in 2024–2026 (2026 still in progress; OpenAlex)
Senior author's track record	3 / 4	Last-listed author Gill Livingston: h-index 99 (OpenAlex, whole career)
Institution's track record	2 / 3	University College London: institution h-index 2,029 (OpenAlex)
Multi-centre collaboration	0 / 3	OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete)
Indexed in PubMed	2 / 2	Indexed in PubMed (PMID 31000129)
Free to read	2 / 2	Free to read
Total	75 / 100	—

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