Pathways Explaining Racial/ethnic and Socio-Economic Disparities in Dementia Incidence: the UK Biobank Study.

Background: Pathways explaining racial/ethnic disparities in dementia risk are under-evaluated. Methods: We examine those disparities and their related pathways among UK Biobank study respondents (50-74 y, N = 323,483; 3.6% non-White minorities) using a series of Cox proportional hazards and generalized structural equations models (GSEM). Results: After <= 15 years, 5,491 all-cause dementia cases were diagnosed. Racial minority status (RACE_ETHN, Non-White vs. White) increased dementia risk by 24% (HR = 1.24, 95% CI: 1.07-1.45, P = 0.005), an association attenuated by socio-economic status (SES), (HR = 1.12, 95% CI: 0.96-1.31). Total race-dementia effect was mediated through both SES and Life's Essential 8 lifestyle sub-score (LE8LIFESTYLE), combining diet, smoking, physical activity, and sleep factors. SES was inversely related to dementia risk (HR = 0.69, 95% CI: 0.67, 0.72, P < 0.001). Pathways explaining excess dementia risk among racial minorities included 'RACE_ETHN(-) -i SES(-) -i DEMENTIA', 'RACE_ETHN(-) -i SES(-) -i Poor cognitive performance, COGN(+) -i DEMENTIA' and 'RACE_ETHN(-) -i SES(+) -i LE8LIFESTYLE(-) -i DEMENTIA'. Conclusions: Pending future interventions, lifestyle factors including diet, smoking, physical activity, and sleep are crucial for reducing racial and socio-economic disparities in dementia.