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Sex differences in dementia risk and risk factors: Individual-participant data analysis using 21 cohorts across six continents from the COSMIC consortium

Gong J 1 , Harris K 1 , Lipnicki DM 2 , Castro-Costa E 3 , Lima-Costa MF 3 , Diniz BS 4 Show all authors , Xiao S 5 , Lipton RB 6 , Katz MJ 6 , Wang C 7 , Preux PM 8 , Guerchet M 8 , Gbessemehlan A 8 , Ritchie K 9 , Ancelin ML 9 , Skoog I 10 , Najar J 10 , Sterner TR 10 , Scarmeas N 11 , Yannakoulia M 12 , Kosmidis MH 13 , Guaita A 14 , Rolandi E 14 , Davin A 14 , Gureje O 15 , Trompet S 16 , Gussekloo J 16 , Riedel-Heller S 17 , Pabst A 17 , Röhr S 17 , Shahar S 18 , Singh DKA 18 , Rivan NFM 18 , Boxtel MV 19 , Köhler S 19 , Ganguli M 20 , Chang CC 20 , Jacobsen E 20 , Haan M 21 , Ding D 22 , Zhao Q 22 , Xiao Z 22 , Narazaki K 23 , Chen T 24 , Chen S 25 , Ng TP 26 , Gwee X 26 , Numbers K 2 , Mather KA 2 , Scazufca M 27 , Lobo A 28 , De-la-Cámara C 28 , Lobo E 29 , Sachdev PS 2 , Brodaty H 2 , Hackett ML 1 , Peters SAE 1 , Woodward M 1 , Cohort Studies of Memory in an International Consortium (COSMIC)

Affiliations 

  • 1 The George Institute for Global Health, University of New South Wales, Sydney, Australia
  • 2 Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
  • 3 Center for Studies in Public Health and Aging Rene Rachou Institute, Oswaldo Cruz Foundation, Belo Horizonte, Brazil
  • 4 UConn Center on Aging, Department of Psychiatry, School of Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
  • 5 Department of Geriatric Psychiatry, Shanghai Mental Health Centre, Shanghai Jiaotong University School of Medicine, Shanghai, China
  • 6 Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
  • 7 Department of Epidemiology and Community Heath, Albert Einstein College of Medicine, Bronx, New York, USA
  • 8 Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
  • 9 INM Institute for Neurosciences of Montpellier, Univ Montpellier, INSERM, Montpellier, France
  • 10 Department of Psychiatry and Neurochemistry, Center for Ageing and Health (Age Cap), University of Gothenburg, Gothenburg, Sweden
  • 11 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
  • 12 Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
  • 13 Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
  • 14 Golgi Cenci Foundation, Abbiategrasso, Italy
  • 15 WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
  • 16 Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
  • 17 Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
  • 18 Centre for Healthy Ageing and Wellness, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
  • 19 Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
  • 20 Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  • 21 Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, USA
  • 22 Institute of Neurology, National Center for Neurological Disorders, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
  • 23 Center for Liberal Arts, Fukuoka Institute of Technology, Fukuoka, Japan
  • 24 Sports and Health Research Center, Department of Physical Education, Tongji University, Shanghai, China
  • 25 Global Health Nursing, Department of Health Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
  • 26 Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore
  • 27 Instituto de Psiquiátria e LIM-23, Hospital da Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
  • 28 Department of Medicine and Psychiatry,  Universidad de Zaragoza, Zaragoza, Spain
  • 29 Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
Alzheimers Dement, 2023 Aug;19(8):3365-3378.
PMID: 36790027 DOI: 10.1002/alz.12962

Abstract

INTRODUCTION: Sex differences in dementia risk, and risk factor (RF) associations with dementia, remain uncertain across diverse ethno-regional groups.

METHODS: A total of 29,850 participants (58% women) from 21 cohorts across six continents were included in an individual participant data meta-analysis. Sex-specific hazard ratios (HRs), and women-to-men ratio of hazard ratios (RHRs) for associations between RFs and all-cause dementia were derived from mixed-effect Cox models.

RESULTS: Incident dementia occurred in 2089 (66% women) participants over 4.6 years (median). Women had higher dementia risk (HR, 1.12 [1.02, 1.23]) than men, particularly in low- and lower-middle-income economies. Associations between longer education and former alcohol use with dementia risk (RHR, 1.01 [1.00, 1.03] per year, and 0.55 [0.38, 0.79], respectively) were stronger for men than women; otherwise, there were no discernible sex differences in other RFs.

DISCUSSION: Dementia risk was higher in women than men, with possible variations by country-level income settings, but most RFs appear to work similarly in women and men.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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