Year of Publication

2016

College

Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Erin Abner, PhD

Committee Member

Thomas Tucker, PhD

Committee Member

Lorie Chesnut, DrPH, MPH

Abstract

Background and Objectives: The purpose of this study was to assess the presence of birth cohort effects by exploring differences in established risk factors of Alzheimer’s disease (AD) and dementia using case-control designs and also estimate the AD risk among women with respect to their number of biological children.

Methods: This is a case control study design of participants born in 1896 – 1955 and were enrolled in one of the designated Alzheimer’s disease centers (ADCs). The uniform Data Set of the National Alzheimer’s Coordinating center (NACC) include those who had Alzheimer’s disease or mild cognitive impairment (cases) and were compared with those who were cognitively (controls) normal using multivariable logistic regression. The study sample was sub-divided into five birth cohorts based on historical periods described above. Specifically, cohorts were constructed for the period leading up and through the end of WWI, Post WWI/the Roaring 20s, Great Depression/Pre WWII, WWII, and Baby Boom Cohort.

Results: Of all the participants enrolled in the ADC UDS and who were born between 1896 and 1955, a total of 22,952 subjects, 12,702 (55.34%) were with AD or MCI and 10,250 (44.66%) were normal controls. Univariate and multivariable logistic regression analyses were performed and the frequency distributions, adjusted odds ratios (ORs), and corresponding 95% confidence intervals (95% CIs) were reported. Females accounted for the majority of participants in all birth cohorts at approximately or exceeding 60%, the Baby Boom (Birth Cohort 5) were youngest at baseline, had the least mean number of children, and highest level of education. After adjusting for all the covariates in the model, age, education, gender and race were seen to be associated 4 with AD and in addition to active smoking, hypertension and diabetes were observed to have variations in the point estimates for cohort-specific risk factors when compared with the overall estimate indicating the evidence of cohort effects.

Conclusion: Evidence of cohort effect was observed in our study as the estimates of risk factors differed among the historically defined birth cohorts. Knowledge of cohort effects is very useful in predicting future trends of AD and dementia and the results from this analysis may strengthen the validity of future studies by informing discussions regarding cohort effects as a threat to epidemiologic investigations

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