Evidence mapPaperPMID 41906138Full record

ArticleAlzheimer's research & therapy2026

Social determinants of health, behavioral factors, and incident dementia: a prospective cohort study.

Hui Zhang, Chongyu Ding, Yaqian Xu, Harong Hao, Yulu Gong, Tongyan An, Zixin Hu, Yi Li, Xiaofeng Wang, Shuai Jiang and 2 more

Abstract read
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Article in Alzheimer's research & therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

12 authors.

Hui ZhangSchool of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China. zhanghui2939@163.com.ORCID 0000-0002-7358-5375
Chongyu DingSchool of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
Yaqian XuSchool of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
Harong HaoSchool of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
Yulu GongSchool of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
Tongyan AnSchool of Public Health, Zhengzhou University, Zhengzhou, 450001, China.
Zixin HuHuman Phenome Institute, Zhangjiang Fudan International Innovation Centre, Fudan University, Shanghai, 201213, China.
Yi LiHuman Phenome Institute, Zhangjiang Fudan International Innovation Centre, Fudan University, Shanghai, 201213, China.
Xiaofeng WangHuman Phenome Institute, Zhangjiang Fudan International Innovation Centre, Fudan University, Shanghai, 201213, China.
Shuai JiangDepartment of Vascular Surgery, Shanghai Key Laboratory of Vascular Lesion Regulationdind Remodeling,Fudan University Pudong Medical Center, Shanghai Pudong Hospital, Shanghai, 201399, China.
Meng HaoDepartment of Geriatrics, Huadong Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.
Xiangwei LiSchool of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China. li.xiangwei@sjtu.edu.cn.

Funding

Health and Retirement Study: Yrs 35-40U01AG009740 · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 1990 to 2025
$96.8M
Expanding the RAND HRS Data System to Better Support Research on Health and AgingR01AG073289 · RAND CORPORATION · 2025 to 2025
$736k
National Natural Science Foundation of China 32300533National Natural Science Foundation of China 82301768NIA NIH HHS R01 AG073289NIA NIH HHS U01 AG009740Startup Fund for Young Faculty at SJTU KJ3-0214-24-0037The startup fund for Principal Investigators from the School of Medicine, Shanghai Jiao Tong University KJ2-0112-23-0002
6 · The paper itself

Abstract

backgroundWhile individual associations between social determinants of health (SDoH), behavioral factors, and incident dementia have been established, the cumulative effect of multiple unfavorable SDoH and their interaction with behavioral factors remains poorly understood. We aimed to examine the independent and joint associations of SDoH and behavioral factors with incident dementia risk in middle-aged and older adults.

methodsThis prospective cohort study utilized data from the Health and Retirement Study. Participants who were dementia-free at baseline, with complete information on SDoH and behavioral factors, and with at least one cognitive assessment during the study period (2006–2020) were included. SDoH, and behavioral factors were sourced from self-reported information. Dementia was assessed biennially using a validated algorithm.

resultsAmong 17,303 initially dementia-free participants (mean baseline age 63.75 [10.43] years, 58.30% women), 1,942 incident dementia cases were documented over a median follow-up of 9.61 years (IQR, 6.33–13.83). After multivariable adjustment, several unfavorable SDoH and behavioral factors were independently associated with higher dementia risk (P-value < 0.05). Among them, less than high school education emerged as the strongest predictor (hazard ratios [HR] 2.64, 95% confidence interval [CI]: 2.37–2.94), followed by lower household income (HR 1.51, 95% CI: 1.33–1.72). A dose–response association of cumulative unfavorable SDoH (HR per additional disadvantage: 1.42, 95% CI: 1.39–1.45) and behavioral factors (HR per additional factor: 1.31, 95% CI: 1.38–1.44) with dementia risk was also observed. Participants with ≥ 5 unfavorable SDoH and ≥ 2 unfavorable behavioral factors had the highest dementia risk (HR 9.22, 95% CI: 7.28–11.66) compared to those with minimal exposures.

conclusionsThis prospective cohort study reveals that cumulative exposure to unfavorable SDoH and behavioral factors is significantly associated with increased dementia incidence, with potential synergistic effects that could amplify risk. Addressing these unfavorable SDoH and maintaining optimal behavioral health is crucial for delaying or preventing dementia.

Indexed as

DementiaSocial Determinants of HealthAgedCohort StudiesFemaleHumansIncidenceMaleMiddle AgedProspective StudiesRisk FactorsBehavioral factorsCohortDementiaSocial determinants of health

Identifiers

PMID41906138
PMCPMC13154487

What Socratic holds

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LicenceCC BY-NC-ND
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.