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Denis A. Evans, MD; Liesi E. Hebert, ScD; Laurel A. Beckett, PhD; Paul A. Scherr, PhD, ScD; Marilyn S. Albert, PhD; Marilyn J. Chown, MPH; David M. Pilgrim, MD; James O. Taylor, MD

Arch Neurol. 1997;54(11):1399-1405.

Abstract
Objective
To assess the relations of 3 measures of socioeconomic status (education, occupational prestige, and income) to risk of incident clinically diagnosed Alzheimer disease (AD).

Design
Cohort study with an average observation of 4.3 years.

Setting
East Boston, Mass, a geographically defined community.

Participants
A stratified random sample of 642 community residents 65 years of age and older who were free of AD at baseline.

Main Outcome Measure
Clinical diagnosis of probable AD according to standard criteria, using structured uniform evaluation.

Results
The relations of the 3 measures of socioeconomic status to risk of disease were assessed using logistic regression analyses. In individual analyses, fewer years of formal schooling, lower income, and lower occupational status each predicted risk of incident AD; risk of disease decreased by approximately 17% for each year of education. In an analysis including all 3 measures, the effect of education on risk for disease remained approximately the same, but the effects of the other 2 measures were somewhat less and did not attain formal statistical significance, compared with separate analysis of each measure.

Conclusions
Markers of lower socioeconomic status predict risk of developing incident AD. The mechanism of this relation is uncertain, but the possibility that it reflects unidentified and potentially reversible risk factors for the disease deserves careful investigation.

Author Affiliations
From the Rush Institute on Aging and Rush Alzheimer's Disease Center of Rush University, Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill (Drs Evans, Hebert, and Beckett); the Health Care and Aging Studies Branch, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga (Dr Scherr); and the Departments of Psychiatry and Neurology, Massachusetts General Hospital (Dr Albert), the Harvard Community Health Plan (Dr Pilgrim), and the Departments of Preventive Medicine (Ms Chown and Dr Taylor), Neurology (Dr Albert), and Psychiatry (Dr Albert), Harvard Medical School, Boston, Mass.

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