Association of Socioeconomic Status With Dementia Diagnosis Among Older Adults in Denmark

Jindong Ding Peterson, Sonja Wehberg, Aake Packness, Nanna Herning Svensson, Nana Hyldig, Soren Raunsgaard, Merethe Kirstine Anderson, Jesper Ryg, Stewart W Mercer, Jens Sondergaard, Frans Boch Waldorff

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Importance: Low socioeconomic status has been identified as a strong risk factor for the development of dementia. However, few studies have investigated the association between socioeconomic status and dementia diagnostic evaluation on a population level.

Objective: To determine whether socioeconomic status is associated with dementia diagnosis and severity at diagnosis.

Design: A cross-sectional study.

Setting: Population- and register-based.

Participants: Individuals who received a first-time referral for diagnostic evaluation of dementia in the secondary healthcare sector in 2017-2018 in Denmark and were registered in the Danish Quality Database for Dementia.

Exposure: As a proxy for socioeconomic status, annual household income of year 2015 and 2016 was obtained from Statistics Denmark and divided into tertiles within five-year interval age groups.

Main Outcomes and Measures: We retrieved dementia diagnoses and cognitive stages at diagnosis (cognitively intact; mild cognitive impairment but not dementia; mild, moderate, or severe dementia) from the database. Uni- and multivariable logistic and linear regressions, adjusting for age group, sex, region of residence, household type, period (years 2017 and 2018), medication, and medical conditions were used to examine the possible associations.

Results: Among 10,191 individuals (mean age 75 years; 53.7% were women) with a first-time referral for diagnostic evaluation of dementia in 2017-2018, 8,844 were diagnosed with dementia. Individuals from households with upper-tertile income were less likely to receive a dementia diagnosis after referral (OR 0.65; 95% CI 0.55 to 0.78) compared to those with lower-tertile income, and when receiving a dementia diagnosis, their cognitive stage was less severe (β -0.16; 95% CI -0.21 to -0.10). Individuals with middle-tertile household income did not significantly differ from individuals with lower-tertile household income in terms of dementia diagnosis (OR 0.92; 95% CI 0.77 to 1.09) or cognitive stage at diagnosis (β 0.01; 95% CI -0.04 to 0.06).

Conclusions and Relevance: Our results reveal a social gradient in dementia diagnostic evaluation in a welfare-oriented country: affluent people seem receiving earlier diagnose. Public health strategies should target less-affluent people for earlier dementia detection and intervention.

Key points: socioeconomic status, dementia, dementia diagnosis, cognitive stage, earlier diagnosis
Original languageEnglish
JournalJAMA Network Open
Publication statusPublished - 18 May 2021


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