Association of Environmental Features and the Risk of Alzheimer’s Dementia in Older Adults: A Nationwide Longitudinal Case-Control Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Data Sources
2.2. Identification for Cases and Controls
2.3. Measurement for Physical and Social Environments
2.4. Levels of Urbanization
2.5. Potential Confounders
2.6. Statistical Analysis
3. Results
4. Discussion
4.1. Main Findings
4.2. Physical and Social Environments and AD in Later Life
4.3. Effects of the Urbanization Levels
4.4. Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variables a | Case | Control | pe | ||
---|---|---|---|---|---|
n | % | n | % | ||
Gender | 1.000 | ||||
Men | 5071 | 40.9 | 5071 | 40.9 | |
Female | 7330 | 59.1 | 7330 | 59.1 | |
Age (years) | 1.000 | ||||
65–69 | 1135 | 9.2 | 1135 | 9.2 | |
70–74 | 2132 | 17.2 | 2132 | 17.2 | |
75–79 | 2692 | 21.7 | 2692 | 21.7 | |
80–84 | 3215 | 25.9 | 3215 | 25.9 | |
≥80 | 3227 | 26.0 | 3227 | 26.0 | |
Mean ± SD b | 79.6 ± 7.2 | 79.3 ± 7.1 | |||
Occupational status | <0.0001 | ||||
White collar | 1479 | 11.9 | 1549 | 12.5 | |
Blue collar | 4608 | 37.1 | 4984 | 40.2 | |
Others | 6314 | 51.0 | 5868 | 47.3 | |
Salary-based insurance premium (NTD) b | |||||
dependents | 4592 | 37.4 | 4622 | 37.2 | <0.0001 |
<Median (19,200) | 3093 | 25.3 | 2829 | 22.8 | |
≥Median | 4578 | 37.3 | 4950 | 39.9 | |
Mean ± SD b,c | 8139.8 ± 11,021.6 | 8718.7 ± 11,517.4 | |||
Number of comorbidities d | 0.0011 | ||||
0 | 4034 | 32.5 | 4181 | 33.7 | |
1–2 | 5985 | 48.3 | 6096 | 49.2 | |
≥3 | 2382 | 19.2 | 2124 | 17.1 | |
Total | 12,401 | 100.0 | 12,401 | 100.0 |
Environmental Features | Percentile | ||||||
---|---|---|---|---|---|---|---|
Min | Max | Mean ± SD a | Q1a | Q2 a | Q3 a | IQR a | |
Physical Environments | |||||||
Parks, greeneries, and square area b | 0 | 25.98 | 0.54 ± 1.50 | 0.14 | 0.29 | 0.55 | 0.41 |
Playgrounds and sport venues b | 0 | 17.76 | 0.97 ± 2.15 | 0.08 | 0.21 | 0.80 | 0.72 |
Community centers c | 0 | 324.75 | 41.95 ± 43.49 | 10.11 | 31.17 | 59.42 | 49.31 |
Social environments | |||||||
Median annual family income d | 339 | 829 | 507.46 ± 68.16 | 465 | 494 | 539 | 74 |
Illiterate people aged ≥65 e | 0.22 | 55.93 | 18.79 ± 11.03 | 10.08 | 16.74 | 26.73 | 16.65 |
Elderly living alone f | 0 | 539.29 | 38.41 ± 51.27 | 10.85 | 18.89 | 46.46 | 35.61 |
Other environments | |||||||
Hospitals and clinics f | 0.72 | 33.82 | 6.43 ± 4.99 | 2.74 | 5.00 | 8.72 | 5.98 |
Variables | No. of Township (Case/Control) | Case | Control | pf | ||
---|---|---|---|---|---|---|
n | % | n | % | |||
Total | 337/338 | 12,401 | 100.0 | 12,401 | 100.0 | |
Physical environments | ||||||
Parks, greeneries, and square area a | 0.6843 | |||||
<Median | 172/172 | 6434 | 51.9 | 6402 | 51.6 | |
≥Median | 165/166 | 5967 | 48.1 | 5999 | 48.4 | |
Playgrounds and sport venues a | 0.0628 | |||||
<Median | 170/169 | 8351 | 67.3 | 8213 | 66.2 | |
≥Median | 167/169 | 4050 | 32.7 | 4188 | 33.8 | |
Community centers b | 0.0499 | |||||
<Median | 173/170 | 10,162 | 82.0 | 10,042 | 81.0 | |
≥Median | 164/168 | 2239 | 18.0 | 2359 | 19.0 | |
Social environments | ||||||
Median annual family income c | 0.0335 | |||||
<Median | 163/166 | 2518 | 20.3 | 2654 | 21.4 | |
≥Median | 174/172 | 9883 | 79.7 | 9747 | 78.6 | |
Illiterate people aged ≥65d | 0.7144 | |||||
<Median | 165/168 | 8381 | 67.6 | 8354 | 67.4 | |
≥Median | 172/170 | 4020 | 32.4 | 4047 | 32.6 | |
Elderly living alone e | 0.7760 | |||||
<Median | 173/170 | 8373 | 67.5 | 8352 | 67.4 | |
≥Median | 164/168 | 4028 | 32.5 | 4049 | 32.6 | |
Other environments | ||||||
Hospitals and clinics e | 0.0080 | |||||
<Median | 168/167 | 1971 | 15.9 | 2126 | 17.1 | |
≥Median | 169/171 | 10,430 | 84.1 | 10,275 | 82.9 | |
Urbanization | 0.0005 | |||||
Rural | 196/199 | 3076 | 24.8 | 3338 | 26.9 | |
Suburban | 113/111 | 5937 | 47.9 | 5714 | 46.1 | |
Urban | 28/28 | 3388 | 27.3 | 3349 | 27.0 |
Variables | Model 1 | Model 2 | Model 3 | Model 4 | Model 5 |
---|---|---|---|---|---|
Intercept (SD) a | 0.02 (0.03) | −0.45 (0.19) * | −0.21 (0.20) | −0.16 (0.21) | −0.20 (0.21) |
Physical environments | |||||
Parks, greeneries, and square area | 1.02 (0.99–1.05) | 1.02 (0.99–1.05) | 1.02 (0.99–1.05) | 1.01 (0.99–1.04) | |
Playgrounds and sport venues | 0.97 (0.96–0.99) * | 0.97 (0.96–0.99) * | 0.97 (0.96–0.99) * | 0.97 (0.96–0.99) * | |
Community centers | 0.92 (0.86–0.99) * | 0.91 (0.83–0.98) * | 0.92 (0.85–1.01) | 0.94 (0.86–1.03) | |
Social environments | |||||
Median annual family income | 1.05 (1.01–1.10) * | 1.02 (0.98–1.07) | 1.01 (0.96–1.06) | 1.01 (0.96–1.05) | |
Illiterate aged ≥65 | 1.04 (0.97–1.12) | 1.04 (0.97–1.12) | 1.06 (0.99–1.14) | 1.08 (0.99–1.16) | |
Elderly living alone | 1.03 (0.99–1.08) | 1.05 (1.01–1.10) * | 1.05 (1.01–1.11) * | 1.05 (1.01–1.11) * |
Variables | Urban areas b | Suburban Areas b | Rural Areas b |
---|---|---|---|
Intercept (SD) a | −0.08 (0.65) | −0.65 (0.37) | 0.28 (0.45) |
Physical environments | |||
Parks, greeneries, and square area | 0.93 (0.76–1.14) | 0.99 (0.93–1.06) | 1.03 (0.99–1.07) |
Playgrounds and sport venues | 1.24 (0.22–6.87) | 0.97 (0.95–1.00) | 0.97 (0.94–0.99) * |
Community centers | 0.78 (0.42–1.44) | 0.96 (0.81–1.14) | 0.89 (0.79–0.99) * |
Social environments | |||
Median annual family income | 1.01 (0.91–1.12) | 1.05 (0.97–1.14) | 0.95 (0.84–1.06) |
Illiterate people aged ≥65 | 1.12 (0.63–2.00) | 1.24 (1.04–1.48) * | 1.03 (0.95–1.13) |
Elderly living alone | 1.02 (0.93–1.12) | 1.06 (0.96–1.16) | 1.11 (1.03–1.20) * |
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Liu, C.-C.; Li, C.-Y.; Kung, S.-F.; Kuo, H.-W.; Huang, N.-C.; Sun, Y.; Hu, S.C. Association of Environmental Features and the Risk of Alzheimer’s Dementia in Older Adults: A Nationwide Longitudinal Case-Control Study. Int. J. Environ. Res. Public Health 2019, 16, 2828. https://doi.org/10.3390/ijerph16162828
Liu C-C, Li C-Y, Kung S-F, Kuo H-W, Huang N-C, Sun Y, Hu SC. Association of Environmental Features and the Risk of Alzheimer’s Dementia in Older Adults: A Nationwide Longitudinal Case-Control Study. International Journal of Environmental Research and Public Health. 2019; 16(16):2828. https://doi.org/10.3390/ijerph16162828
Chicago/Turabian StyleLiu, Chih-Ching, Chung-Yi Li, Shiann-Far Kung, Hsien-Wen Kuo, Nuan-Ching Huang, Yu Sun, and Susan C. Hu. 2019. "Association of Environmental Features and the Risk of Alzheimer’s Dementia in Older Adults: A Nationwide Longitudinal Case-Control Study" International Journal of Environmental Research and Public Health 16, no. 16: 2828. https://doi.org/10.3390/ijerph16162828