The Potential of Social Policies in Preventing Dementia: An Ecological Study Using Systematic Review and Meta-Analysis

ABSTRACT

Social policies determine the distribution of factors (e.g. education, cardiovascular health) protecting against the development of dementia in Alzheimer’s disease (AD). However, the association between social policies and the likelihood of AD without dementia (ADw/oD) has yet to be evaluated. We estimated this association in an ecological study using systematic review and meta-analysis. Four reference databases were consulted; 18 studies were included in the final analysis. ADw/oD was defined as death without dementia in people with clinically significant AD brain pathology. The indicators of social policy were extracted from the Organisation for Economic Co-operation and Development database (OECD). The probability of ADw/oD with moderate AD brain pathology was inversely associated with the Gini index for disposable income, poverty rate, and certain public expenditures on healthcare. ADw/oD with advanced AD brain pathology was only associated with public expenditures for long-term care. Social policies may play a role in maintaining and sustaining cognitive health among older people with AD.

KEYWORDS:

• Alzheimer disease
• dementia
• preclinical Alzheimer disease
• public policies
• public policy
• secondary prevention
• social determinants of health
• social policies
• social policy

Key points

• The role of social policies in the probability of Alzheimer’s disease without dementia in Western countries (ADw/oD) has not yet been assessed.

• We estimated the associations between the probability of ADw/oD (no dementia in life, AD-brain pathology) and social policy indicators. This probability was associated with the inequality of disposable income and the poverty rate. Certain public expenditures for healthcare were also associated with the probability of ADw/oD.

• Social policies on income distribution and access to healthcare might be considered a tool for decreasing the burden of dementia.

Disclosure statement

No potential conflict of interest was reported by the authors.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/08959420.2023.2245672

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.