To analyze the association of urbanicity with dementia mortality and identify modifiable neighborhood factors contributing to excess risk.
Approach:
Study Design: Population-based, national linked cohort study covering approximately 41 million residents in England with follow-up from 2011 to 2023.
Data Collection: Utilized linked census records and death registrations, with a focus on dementia mortality defined by underlying-cause and any-mention criteria.
Urbanicity Measurement: Characterized using neighborhood population density as a proxy indicator.
Cohort Characteristics: Included 7,091,680 records after exclusions, representing individuals across 32,844 lower super output areas.
Outcome Definitions: Primary outcome was dementia as the underlying cause of death; secondary outcome was any mention of dementia on death certificates.
Neighborhood Conditions: Included socioeconomic and environmental measures derived from UK governmental databases.
Key Findings:
Urbanicity is associated with dementia mortality, with higher risks observed in areas of increased population density.
Socioeconomic and environmental factors significantly contribute to the associations between urbanicity and dementia mortality.
Modifiable neighborhood factors may present opportunities for reducing dementia deaths.
Interpretation:
The study provides evidence on the impact of urban environments on dementia mortality and the role of neighborhood conditions.
Limitations:
Prior studies used inconsistent rural-urban classifications, limiting comparability.
Limited evidence on dose-response associations across the full urbanicity spectrum.
Small sample sizes and cross-sectional designs in previous research.
Conclusion:
Further evidence is necessary to inform policies aimed at addressing dementia mortality in urban settings.
