Gender Differences in Environmental Influences on Dementia Incidence in Germany 2014-2019: an Observational Cohort Study Based on Health Claims Data.

Daniel Kreft, University of Rostock
Gabriele Doblhammer , University of Rostock

Whether environmental characteristics influence dementia risk in addition to individual characteristics is the subject of ongoing debate. Consideration of gender actually complicates the relationship, as risk factors may vary in effect size or frequency between the two gender, or the two gender may exhibit different susceptibility. We try to uncover the influence of regional characteristics on the incidence of dementia and to explore gender differences using individual-level health information and objective regional characteristics. Based on a random sample of 250.000 members aged 50 and above of the largest German public health insurance we analyzed quarterly data over the period 2014 to 2017. Using five-digit zip codes, we added external data on various dimensions of regional characteristics. We used multilevel survival regressions to tease out regional incidence differences while accounting for spatial clustering. After adjusting for multi-morbidity and relocation-related selection bias, men living in regions with the highest tertile of income and remaining life expectancy at age 60, and those living closest to nature had lower dementia risks. For women only the regional income effect was significant and similar to those of men. Our findings suggest that both sexes living in low-income neighborhoods should be targeted for dementia prevention. In addition, further studies are needed to examine whether the gendered effects of health resources, measured as remaining life expectancy and near-natural space, are related to differences in lifestyle. While women may generally engage in healthier activities, they may be less likely than men to engage in physical activity in nature.

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 Presented in Session 34. Climate Change, Air Pollution and Health