Socioeconomic status in relationship to death of vascular disease and late-life dementia

It is unclear to what extent coronary heart disease (CHD) and ischemic stroke share several biochemicals clinical and other risk factors with dementia and Alzheimer Disease. Socioeconomic status (SES) has been linked to vascular disease in some investigations and to dementia in a few others. We followed 10,000 Jewish male civil servants in Israel, initially examined in 1963, for mortality. Close to 2000 Survivors of this cohort were assessed between 1999 and 2001 for dementia and AD, yielding 309 cases of dementia. A 5-scale Socioeconomic status (SES) rank, defined during working years, on the basis of education and occupation, was directly but weakly related to CHD mortality but exhibited a clear inverse association with stroke mortality: hazard ratio (HR) 0.89 (95% CI, 0.81–0.97) per “1 step” of SES rank. A similar but more profound association was found for the prevalence of dementia, years later, among long-term survivors. Those at the lowest SES ranks exhibited estimated 3-fold and 6-fold dementia rates. The results are consistent with a “protective” mechanism associated with high education, but survival bias could affect these results and long-term incidence studies of dementia should clarify the SES–dementia association.