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What does (low) education mean in terms of dementia risk? A systematic review and meta-analysis highlighting inconsistency in measuring and operationalising education.

ABSTRACT: Low education is considered an important modifiable risk factor for dementia worldwide, despite the lack of a formal consensus definition of low education. The primary aim of this systematic review was to document and address the inconsistency in measuring and operationalising education in dementia studies. A secondary aim was to consider the dose of education required to reduce dementia risk. The protocol was registered at PROSPERO with registration ID CRD42018096168. CINAHL, Cochrane, PsycInfo, and Pubmed databases were searched using terms related to education, dementia and/or MCI, and incidence. Studies were eligible for inclusion if a risk ratio for education and any dementia, Alzheimer's Disease (AD), Vascular Dementia (VaD) or Mild Cognitive Impairment (MCI) was reported in a population cognitively healthy at baseline. Sample sizes for 65 studies meeting selection criteria ranged from 152 to 12,881, representing populations from 24 countries. Risk of bias, assessed using a tool designed specifically for dementia risk studies, was found to be medium or low for all studies. There were 23 continuous, 29 dichotomous, and 31 categorical operationalisations of education reported. Random effects meta-analyses from continuous operationalisations suggested each year of education reduced risk by eight percent for AD (95% CI:5-12%) and seven percent for any dementia (95% CI:6-9%). Dichotomous operationalisations indicated an increased risk for low education of 45% (95% CI:29-63%) for any dementia and 85% (95% CI:56-118%) for AD, however definitions of low education were heterogeneous, ranging from zero to 12 years. There were too few studies to produce summary ratios for VaD or MCI. We conclude that, while the evidence of an association between low education and dementia incidence is robust, inconsistency in the definition, measurement and operationalisation of education hinders the translation of this evidence into practical policy recommendations to reduce dementia risk.

SUBMITTER: Maccora J

PROVIDER: S-EPMC7721642 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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What does (low) education mean in terms of dementia risk? A systematic review and meta-analysis highlighting inconsistency in measuring and operationalising education.

Maccora Janet J Peters Ruth R Anstey Kaarin J KJ

SSM - population health 20200829

Low education is considered an important modifiable risk factor for dementia worldwide, despite the lack of a formal consensus definition of low education. The primary aim of this systematic review was to document and address the inconsistency in measuring and operationalising education in dementia studies. A secondary aim was to consider the dose of education required to reduce dementia risk. The protocol was registered at PROSPERO with registration ID CRD42018096168. CINAHL, Cochrane, PsycInfo ...[more]

PMID: 33313373

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Project description:BACKGROUND:Minorities' Diminished Returns (MDRs) refer to systemically weaker effects of socioeconomic status (SES) indicators on various developmental, behavioral, and health outcomes of ethnic minorities compared to non-Hispanic (non-Latino) Whites. Similar MDRs also exist for the effects of parental education on the school performance of ethnic minority youth. AIM:To assess whether regression toward the mean (RTM) has any role in explaining the diminished effects of parental education on the school performance of Black and Hispanic youth relative to non-Hispanic White youth. MATERIALS AND METHODS:Data for this cross-sectional study came from the Monitoring the Future survey (MTF, 2017), a nationally representative survey of American youth in 12th grade. The sample included 10,262 youth who were 12th graders (typically 17-18 years old). The independent variable was parental education with five categories: Some high school, High school graduate, Some college, College graduate, and Graduate school. The outcome was self-reported school performance measured as grade point average (GPA). Ethnicity was the effect modifier. Analysis of variance (ANOVA) and the Tukey Post Hoc test was used to analyze the data. Data visualization (line graphs) was used to visualize the shape of youth GPA as a function of parental education levels across ethnic groups. RESULTS:While a perfect stepwise increase was seen in youth school performance as a result of parental education improvement, this pattern differed considerably across ethnic groups. Such a perfect stepwise increase in youth school performance as a result of the incremental increase in parental education was missing for Black and Hispanic youth. The shape of the association between parental education and youth school performance ruled out regression toward the mean (RTM) as an explanation for the observed diminished effects of parental education on the school performance of Black and Hispanic youth. CONCLUSION:Diminished returns of parental education on the school performance of Black and Hispanic youth cannot be explained by regression toward the mean. Other factors and contextual processes, such as segregation, discrimination, racism, and poor quality of schools in urban areas, should be investigated in future research.

Project description:IntroductionA participatory approach to co-creating new knowledge in health research has gained significant momentum in recent decades. This is founded on the described benefits of community-based participatory research (CBPR), such as increased relevance of research for those who must act on its findings. This has prompted researchers to better understand how CBPR functions to achieve these benefits through building sustainable research partnerships. Several studies have identified 'trust' as a key mechanism to achieve sustainable partnerships, which themselves constitute social networks. Although existing literature discuss trust and CBPR, or trust and social networks, preliminary searches reveal that none link all three concepts of trust, CBPR and social networks. Thus, we present our scoping review protocol to systematically review and synthesise the literature exploring how trust is conceptualised, operationalised and measured in CBPR and social networks.Methods and analysisThis protocol follows guidelines from Levac et al (Scoping studies: advancing themethodology. Implement Sci 2010;5:69), which follow the methodological framework of Arksey and O'Malley. This scoping review explores several electronic databases including Scopus, Medline, PubMed, Web of Science, CINAHL, Cochrane Library, Google Scholar and PsychINFO. Grey literature such as theses/dissertations and reports will be included. A search strategy was identified and agreed on by the team in conjunction with a research librarian. Two independent reviewers will screen articles by title and abstract, then by full text based on pre-determined exclusion/inclusion criteria. A third reviewer will arbitrate discrepancies regarding inclusions/exclusions. We plan to incorporate a thematic analysis.Ethics and disseminationEthics is not required for this review specifically. It is a component of a larger study that received ethical approval from the University of Limerick research ethics committee (#2018_05_12_EHS). Translation of results to key domains is integrated through active collaboration of stakeholders from community, health services and academic sectors. Findings will be disseminated through academic conferences, and peer review publications targeting public and patient involvement in health research.

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What does (low) education mean in terms of dementia risk? A systematic review and meta-analysis highlighting inconsistency in measuring and operationalising education.

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What does (low) education mean in terms of dementia risk? A systematic review and meta-analysis highlighting inconsistency in measuring and operationalising education.

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