Community-level educational attainment and dementia: a 6-year longitudinal multilevel study in Japan

Abstract Background As the understanding of the association between community-level education and dementia is insufficient, this study examined the contextual association of community-level prevalence of low educational attainment on the risk of dementia incidence. With this study, we further explor...

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Autores principales:	Tomo Takasugi, Taishi Tsuji, Masamichi Hanazato, Yasuhiro Miyaguni, Toshiyuki Ojima, Katsunori Kondo
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Socioeconomic status Education Cognitive decline JAGES cohort Multilevel analysis Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/fe5aaa2479214346ab9da73515a41055
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spelling	oai:doaj.org-article:fe5aaa2479214346ab9da73515a410552021-11-28T12:09:01ZCommunity-level educational attainment and dementia: a 6-year longitudinal multilevel study in Japan10.1186/s12877-021-02615-x1471-2318https://doaj.org/article/fe5aaa2479214346ab9da73515a410552021-11-01T00:00:00Zhttps://doi.org/10.1186/s12877-021-02615-xhttps://doaj.org/toc/1471-2318Abstract Background As the understanding of the association between community-level education and dementia is insufficient, this study examined the contextual association of community-level prevalence of low educational attainment on the risk of dementia incidence. With this study, we further explored the potential differences in the aforementioned associations for urban and non-urban areas. Methods We analyzed 6 years of prospective cohort data from the Japan Gerontological Evaluation Study, beginning with the baseline data collected between 2010 and 2012, for 51,186 physically and cognitively independent individuals aged ≥65 years (23,785 men and 27,401 women) from 346 communities in 16 municipalities across 7 prefectures. We assessed dementia incidence using available data from the long-term care insurance system in Japan. We dichotomized education years as ≤9 and ≥ 10 years and aggregated individual-level educational attainment as a community-level independent variable. Model 1 covariates were age and sex. Income, residential years, disease, alcohol, smoking, social isolation, and population density were added in Model 2. We conducted multiple imputation to address the missing data. We performed a two-level (community and individual) survival analysis to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results The results indicate that the cumulative incidence of dementia during the follow-up period was 10.6%. The mean proportion with educational attainment of ≤9 years was 40.8% (range: 5.1–87.3%). Low community-level educational attainment was significantly associated with higher dementia incidence (HR: 1.04; 95% CI: 1.01–1.07), estimated by 10 percentage points of low educational attainment after adjusting for individual-level educational years and covariates. While the association was significant in non-urban areas (HR: 1.07; 1.02–1.13), there was no association in urban areas (HR: 1.03; 0.99–1.06). Conclusions Older people living in communities with low educational attainment among their age demographic develop dementia more often compared with those living in areas with high educational attainment after adjusting for individual-level educational attainment and covariates; the association was pronounced in non-urban areas. Securing education for adolescents as a life course and population approach could thus be crucial in preventing dementia later in life among older people living in non-urban areas.Tomo TakasugiTaishi TsujiMasamichi HanazatoYasuhiro MiyaguniToshiyuki OjimaKatsunori KondoBMCarticleSocioeconomic statusEducationCognitive declineJAGES cohortMultilevel analysisGeriatricsRC952-954.6ENBMC Geriatrics, Vol 21, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Socioeconomic status Education Cognitive decline JAGES cohort Multilevel analysis Geriatrics RC952-954.6
spellingShingle	Socioeconomic status Education Cognitive decline JAGES cohort Multilevel analysis Geriatrics RC952-954.6 Tomo Takasugi Taishi Tsuji Masamichi Hanazato Yasuhiro Miyaguni Toshiyuki Ojima Katsunori Kondo Community-level educational attainment and dementia: a 6-year longitudinal multilevel study in Japan
description	Abstract Background As the understanding of the association between community-level education and dementia is insufficient, this study examined the contextual association of community-level prevalence of low educational attainment on the risk of dementia incidence. With this study, we further explored the potential differences in the aforementioned associations for urban and non-urban areas. Methods We analyzed 6 years of prospective cohort data from the Japan Gerontological Evaluation Study, beginning with the baseline data collected between 2010 and 2012, for 51,186 physically and cognitively independent individuals aged ≥65 years (23,785 men and 27,401 women) from 346 communities in 16 municipalities across 7 prefectures. We assessed dementia incidence using available data from the long-term care insurance system in Japan. We dichotomized education years as ≤9 and ≥ 10 years and aggregated individual-level educational attainment as a community-level independent variable. Model 1 covariates were age and sex. Income, residential years, disease, alcohol, smoking, social isolation, and population density were added in Model 2. We conducted multiple imputation to address the missing data. We performed a two-level (community and individual) survival analysis to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results The results indicate that the cumulative incidence of dementia during the follow-up period was 10.6%. The mean proportion with educational attainment of ≤9 years was 40.8% (range: 5.1–87.3%). Low community-level educational attainment was significantly associated with higher dementia incidence (HR: 1.04; 95% CI: 1.01–1.07), estimated by 10 percentage points of low educational attainment after adjusting for individual-level educational years and covariates. While the association was significant in non-urban areas (HR: 1.07; 1.02–1.13), there was no association in urban areas (HR: 1.03; 0.99–1.06). Conclusions Older people living in communities with low educational attainment among their age demographic develop dementia more often compared with those living in areas with high educational attainment after adjusting for individual-level educational attainment and covariates; the association was pronounced in non-urban areas. Securing education for adolescents as a life course and population approach could thus be crucial in preventing dementia later in life among older people living in non-urban areas.
format	article
author	Tomo Takasugi Taishi Tsuji Masamichi Hanazato Yasuhiro Miyaguni Toshiyuki Ojima Katsunori Kondo
author_facet	Tomo Takasugi Taishi Tsuji Masamichi Hanazato Yasuhiro Miyaguni Toshiyuki Ojima Katsunori Kondo
author_sort	Tomo Takasugi
title	Community-level educational attainment and dementia: a 6-year longitudinal multilevel study in Japan
title_short	Community-level educational attainment and dementia: a 6-year longitudinal multilevel study in Japan
title_full	Community-level educational attainment and dementia: a 6-year longitudinal multilevel study in Japan
title_fullStr	Community-level educational attainment and dementia: a 6-year longitudinal multilevel study in Japan
title_full_unstemmed	Community-level educational attainment and dementia: a 6-year longitudinal multilevel study in Japan
title_sort	community-level educational attainment and dementia: a 6-year longitudinal multilevel study in japan
publisher	BMC
publishDate	2021
url	https://doaj.org/article/fe5aaa2479214346ab9da73515a41055
work_keys_str_mv	AT tomotakasugi communityleveleducationalattainmentanddementiaa6yearlongitudinalmultilevelstudyinjapan AT taishitsuji communityleveleducationalattainmentanddementiaa6yearlongitudinalmultilevelstudyinjapan AT masamichihanazato communityleveleducationalattainmentanddementiaa6yearlongitudinalmultilevelstudyinjapan AT yasuhiromiyaguni communityleveleducationalattainmentanddementiaa6yearlongitudinalmultilevelstudyinjapan AT toshiyukiojima communityleveleducationalattainmentanddementiaa6yearlongitudinalmultilevelstudyinjapan AT katsunorikondo communityleveleducationalattainmentanddementiaa6yearlongitudinalmultilevelstudyinjapan
_version_	1718408177407492096

Community-level educational attainment and dementia: a 6-year longitudinal multilevel study in Japan

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