Old-age dementias are known to disproportionally affect women as well as individuals with low educational attainment. The higher lifetime risk of dementia among women is usually attributed to their longer life expectancy. However, the impact of sex, and subsequent gender inequity, is likely to be more multifaceted than this explanation implies. Not least because of historical inequities in access to education between the sexes and the gender and socio-economic gradients in risk factors such as stress, depression and social isolation. Consequently, the present study sought to test whether differences in educational attainment and experiences of general psychological distress mediate the association between female sex and dementia. The study utilizes data obtained through the Gothenburg H70 Birth Cohort Study and the Prospective Populations Study on Women (n = 892). Data were analysed using Confirmatory Factor Analysis (CFA) and Structural Equation Modelling (SEM) with Weighted Least Squares Means and Variance adjusted (WLSMV) estimation. General psychological distress was indicated by a latent variable and constructed from five manifest items (previous depression, stress, self-esteem, chronic loneliness and satisfaction with social situation) that were all measured at baseline. While the results could not corroborate that education directly mediates the effect of sex on dementia, level of distress was predicted by both female sex (0.607, p < .001) and education (− 0.166, p < .01) and, in turn, shown to be significantly associated with dementia (0.167, p < .05), also after controlling for confounders. When time from baseline to diagnosis was increased through sequential exclusion of dementia cases, the effect of distress on dementia was no longer significant. The overall findings suggest that social (dis) advantage predicts general psychological distress, which thereby constitutes a potential, and rarely acknowledged, pathway between female sex, education, and dementia. They further underline the importance of attending to both education and distress as ‘gendered’ phenomena when considering the nature of their associations with dementia. However, the possibility of reverse causality bias must be acknowledged and the need for longitudinal studies with longer follow-up stressed.

中文翻译：

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痴呆症的性别差异：受教育程度和心理困扰经历的潜在中介作用。

已知老年痴呆症对妇女以及受教育程度低的人的影响不成比例。妇女痴呆症终生风险较高通常是由于她们的预期寿命更长。但是，性别的影响以及随后的性别不平等可能比该解释所暗示的更为复杂。尤其是由于性别和性别之间的受教育历史不平等以及压力，抑郁和社会孤立等危险因素的社会经济梯度。因此，本研究试图检验受教育程度和一般心理困扰经历的差异是否介导了女性与痴呆症之间的联系。该研究利用了哥德堡H70出生队列研究和妇女前瞻性人群研究（n = 892）获得的数据。使用验证性因子分析（CFA）和结构方程模型（SEM）进行数据分析，并采用加权最小二乘均值和方差调整（WLSMV）估计。一般的心理困扰由潜在变量指示，由五个明显的项目（以前的抑郁，压力，自尊，慢性孤独和对社会状况的满意程度）构成，这些项目均在基线时进行测量。虽然该结果不能证实教育直接介导了性别对痴呆症的影响，但女性（0.607，p <.001）和教育（-0.166，p <.01）都预测了痛苦水平，因此，表现出与痴呆症显着相关（0.167，p <.05），在控制混杂因素之后。当通过顺序排除痴呆病例而增加从基线到诊断的时间时，困扰对痴呆的影响不再显着。总体发现表明，社会（疾病）优势预示着普遍的心理困扰，从而构成了女性，教育和痴呆之间的一种潜在途径，并且鲜为人知。他们进一步强调，在考虑与痴呆症的关系时，将教育和痛苦视为“性别”现象非常重要。但是，必须认识到因果关系存在逆向偏差的可能性，并且需要进行长期随访的纵向研究。当通过顺序排除痴呆病例而增加从基线到诊断的时间时，困扰对痴呆的影响不再显着。总体发现表明，社会（疾病）优势预示着普遍的心理困扰，从而构成了女性，教育和痴呆之间的一种潜在途径，并且鲜为人知。他们进一步强调，在考虑与痴呆症的关系时，将教育和痛苦视为“性别”现象非常重要。但是，必须认识到因果关系存在反向偏差的可能性，并且需要进行长期随访的纵向研究。当通过顺序排除痴呆病例而增加从基线到诊断的时间时，困扰对痴呆的影响不再显着。总体发现表明，社会（疾病）优势预示着普遍的心理困扰，从而构成了女性，教育和痴呆之间的一种潜在途径，并且很少被人们认识。他们进一步强调，在考虑与痴呆症的关系时，将教育和痛苦视为“性别”现象非常重要。但是，必须认识到因果关系存在逆向偏差的可能性，并且需要进行长期随访的纵向研究。因此，它构成了女性，教育和痴呆之间的一种潜在途径，并且很少被人们认可。他们进一步强调，在考虑与痴呆症的关系时，将教育和痛苦视为“性别”现象非常重要。但是，必须认识到因果关系存在反向偏差的可能性，并且需要进行长期随访的纵向研究。因此，它构成了女性，教育和痴呆之间的一种潜在途径，并且很少被人们认可。他们进一步强调，在考虑与痴呆症的关系时，将教育和痛苦视为“性别”现象非常重要。但是，必须认识到因果关系存在反向偏差的可能性，并且需要进行长期随访的纵向研究。