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Could Country-Level Factors Explain Sex Differences in Dementia Incidence and Prevalence? A Systematic Review and Meta-Analysis

Lookup NU author(s): Professor Fiona MatthewsORCiD

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


Abstract

BACKGROUND: Despite rising interest in sex differences in dementia, it is unclear whether sex differences in dementia incidence and prevalence are apparent globally. OBJECTIVE: We examine sex differences in incidence and prevalence of Any dementia, Alzheimer's disease (AD), and vascular dementia (VaD), and evaluate whether country-level indicators of gender inequality account for differences. METHODS: Systematic review with meta-analysis was used to obtain estimates of incidence and prevalence of Any dementia, AD, and VaD using random effects meta-analysis, and population-based studies with clinical or validated dementia measures. Meta-regression was used to evaluate how country-specific factors of life expectancy, education, and gender differences in development, unemployment, and inequality indices influenced estimates. RESULTS: We identified 205 eligible studies from 8,731 articles, representing 998,187 participants across 43 countries. There were no sex differences in the incidence of Any dementia, AD, or VaD, except in the 90+ age group (women higher). When examined by 5-year age bands, the only sex difference in prevalence of Any dementia was in the 85+ group and there was no sex difference in VaD. AD was more prevalent in women at most ages. Globally, the overall prevalence of dementia in adults 65 + was higher for women (80.22/1000, 95% CI 62.83-97.61) than men (54.86/1000, 95% CI 43.55-66.17). Meta-regression revealed that sex differences in Any dementia prevalence were associated with gender differences in life expectancy and in education. CONCLUSION: Globally, there are no sex differences in age-specific dementia incidence, but prevalence of AD is higher in women. Country-level factors like life expectancy and gender differences in education may explain variability in sex differences.


Publication metadata

Author(s): Huque H, Eramudugolla R, Chidiac B, Ee N, Ehrenfeld L, Matthews FE, Peters R, Anstey KJ

Publication type: Article

Publication status: Published

Journal: Journal of Alzheimer's Disease

Year: 2023

Volume: 91

Issue: 4

Pages: 1231-1241

Print publication date: 14/02/2023

Online publication date: 22/12/2022

Acceptance date: 06/12/2022

Date deposited: 09/03/2023

ISSN (print): 1387-2877

ISSN (electronic): 1875-8908

Publisher: IOS Press

URL: https://doi.org/10.3233/JAD-220724

DOI: 10.3233/JAD-220724

PubMed id: 36565114


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Funding

Funder referenceFunder name
1100579
1102694
ARC Centre of Excellence in Population Ageing Research
FL190100011
NHMRC Dementia Centre for Research Collaboration

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