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The association between the area deprivation index and dementia in a Veteran Population
Christina S. Dintica, Amber L. Bahorik, Feng Xia, Amy Kind, Kristine S. Yaffe. Alzheimer s & Dementia, 2023-12-01
Topic: Risk, prevention and care in population studies
Plain-language summary
Abstract Background Residence in a disadvantaged neighborhood is associated with adverse health exposures and outcomes, and may increase risk for cognitive impairment and dementia. We investigated the association of the area deprivation index (ADI) with dementia in in a sample of the national Veteran population. Methods We examined data from the Veterans Health Administration (VHA), the largest integrated health care system in the United States. We studied 1,613,337 patients who obtained VHA care from 10/1/1999 to 9/30/2021, (n = 1,395,872 White; n = 147,530 Black) aged ≥55 years (mean: 68.6, SD: 7.7), 98% male. We characterized neighborhood deprivation with the ADI, a validated measure that combines 17 specific indicators (e.g., income, education, employment and housing) into an index of disadvantage. Participant zip codes from residential addresses were geocoded and assigned an ADI national rank according to their census block group. We used these data to categorize participants into ADI rank quintiles, where higher ADI rank quintile corresponds with more deprivation. We estimated adjusted incidence rates of dementia (International Classification of Diseases, 9th and 10th Edition codes) using Cox proportional hazards regression with age as the time scale. Results During a mean follow‐up of up to 11 (SD 4.8) years, 208,909 participants (12.8%) developed dementia. Compared to the least disadvantaged neighborhood quintile, all other groups had an increased risk of developing dementia in models adjusted for sex, race/ ethnicity, and psychiatric and medical comorbidities. The association was dose‐dependent, with the most disadvantaged quintile demonstrating the greatest risk (Quintile 2 HR: 1.09 95% CI: 1.07, 1.11; Quintile 3 HR: 1.14, 95% CI: 1.12, 1.16; Quintile 4 HR: 1.17, 95% CI: 1.16, 1.19, Quintile 5 HR: 1.24, 95% CI: 1.22, 1.26, Quintile 1 reference group). Repeating our main analysis using competing risks regression led to similar results. Conclusion We found a dose‐dependent association between ADI and dementia The ADI may be a valuable tool for identifying high‐risk communities for dementia intervention.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Dintica, C. S., Bahorik, A. L., Xia, F., Kind, A., & Yaffe, K. S. (2023). The association between the area deprivation index and dementia in a Veteran Population. Alzheimer s & Dementia. https://doi.org/10.1002/alz.075933
Vancouver
Dintica CS, Bahorik AL, Xia F, Kind A, Yaffe KS. The association between the area deprivation index and dementia in a Veteran Population. Alzheimer s & Dementia. 2023. doi:10.1002/alz.075933.
BibTeX
@article{dintica2023-cf50c9a9,
author = {Dintica, Christina S. and Bahorik, Amber L. and Xia, Feng and Kind, Amy and Yaffe, Kristine S.},
title = {{The association between the area deprivation index and dementia in a Veteran Population}},
journal = {Alzheimer s \& Dementia},
year = {2023},
doi = {10.1002/alz.075933},
url = {https://doi.org/10.1002/alz.075933}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
Key findings
- Abstract Background Residence in a disadvantaged neighborhood is associated with adverse health exposures and outcomes, and may increase risk for cognitive impairment and dementia.
- Results During a mean follow‐up of up to 11 (SD 4.8) years, 208,909 participants (12.8%) developed dementia.
- Compared to the least disadvantaged neighborhood quintile, all other groups had an increased risk of developing dementia in models adjusted for sex, race/ ethnicity, and psychiatric and medical comorbidities.
- Repeating our main analysis using competing risks regression led to similar results.
- Conclusion We found a dose‐dependent association between ADI and dementia The ADI may be a valuable tool for identifying high‐risk communities for dementia intervention.
Why it matters
Among 1,613,337 veterans, 208,909 (12.8%) developed dementia, and compared to the least disadvantaged neighborhood quintile, all other groups had an increased risk of developing dementia after adjustment for sex, race/ethnicity, and psychiatric and medical comorbidities. The study is about the association between neighborhood deprivation and dementia risk, not about treating, curing, or preventing Alzheimer's disease.
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Study details
- Participants1,395,872
- Effect size12.8%; HR: 1.09; HR: 1.14
- Evidence strengthLow
How this study scored 44/100
Published in a peer-reviewed journal. Scored zero for study design and randomized / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Alzheimer s & Dementia) |
| Journal's citation record | 2 / 4 | Alzheimer s & Dementia: journal h-index 228 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2023 — within 6 year(s) of the newest study here |
| Sample size | 4 / 4 | 1,395,872 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 0 / 7 | Cited 0 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.0 citations a year over 5 year(s) since 2023 |
| Impact for its field and year | 0 / 6 | Cited 0.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Kristine S. Yaffe: h-index 155 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of California, San Francisco: institution h-index 1,915 (OpenAlex) |
| Multicenter collaboration | 2 / 3 | OpenAlex lists 4 institution(s) in 1 country |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 2 / 2 | Free to read |
| Total | 44 / 100 | — |
What each of these 20 components measures, and what this score is not →
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