J Korean Med Sci.  2017 Sep;32(9):1508-1515. 10.3346/jkms.2017.32.9.1508.

Effect of Individual and District-level Socioeconomic Disparities on Cognitive Decline in Community-dwelling Elderly in Seoul

  • 1Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea. jjeong@ewha.ac.kr
  • 2Gangseo Dementia Center, Seoul, Korea.
  • 3Ewha Brain Institute, Ewha Womans University, Seoul, Korea.
  • 4Department of Preventive Medicine, Ewha Womans University College of Medicine, Seoul, Korea.
  • 5Department of Psychiatry, Seoul National University Hospital, Seoul, Korea.
  • 6Seoul Metropolitan Center for Dementia, Seoul, Korea.
  • 7Department of Molecular Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
  • 8Department of Neurology, Inha University School of Medicine, Incheon, Korea.
  • 9Yangcheon Dementia Center, Seoul, Korea.
  • 10Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju, Korea.


This study was to investigate the effects of individual and district-level socioeconomic status (SES) on the development of cognitive impairment among the elderly. A 3-year retrospective observational analysis (2010-2013) was conducted which included 136,217 community-dwelling healthy elderly who participated in the Seoul Dementia Management Project. Cognitive impairment was defined as 1.5 standard deviations below the norms on the Mini-mental status examination. In the individual lower SES group, the cumulative incidence rate (CIR) of cognitive impairment was 8.7% (95% confidence interval [CI], 8.64-8.70), whereas the CIR in the individual higher SES group was 4.1% (95% CI, 4.08-4.10). The CIR for lower district-level SES was 4.7% (95% CI, 4.52-4.86), while that in the higher district-level SES was 4.3% (95% CI, 4.06-4.44). There were no additive or synergistic effects between individual and district-level SES. From this study, the individual SES contributed 1.9 times greater to the development of cognitive impairment than the district-level SES, which suggests that individual SES disparities could be considered as one of the important factors in public health related to cognitive impairment in the elderly.


Individual SES; District-level SES; Cognitive Impairment

MeSH Terms

Cognition Disorders
Public Health
Retrospective Studies
Social Class
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