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Inequalities in risk of dementia in people with multiple long-term conditions: a cohort study in English primary care data

Year: 2026
Type: article
Abstract: Background and aims Limited research has explored inequalities in dementia risk among individuals with existing multiple long-term conditions (at least two chronic conditions), while treating death as a competing event. Existing studies rarely disaggregate dementia risk by subgroup. Methods Fine-Gray competing risk of death analyses were conducted in a cohort of individuals with at least two chronic conditions using Clinical Practice Research Datalink primary care data linked to the Index of Multiple Deprivation. Analyses were conducted in subgroups of sex (male and female) and deprivation (low, middle and high). Results There were of 908,473 individuals with multiple long-term conditions in this cohort with an average of 13.1 years follow-up. A Fine-Gray model indicated that women had a 26% increased risk of recorded dementia compared to men (subdistribution hazard ratio (sHR) 1.26, 95% confidence interval (CI) 1.23-1.28) after accounting for death as a competing risk. The high and middle deprivation groups experienced a lower risk of recorded dementia compared to the most affluent group (sHR 0.89, 95% CI 0.86-0.92 and sHR = 0.91, 95% CI 0.89-0.94 respectively) after accounting competing mortality. On average, the high deprivation group experienced onset of multiple long-term conditions three years earlier, dementia onset two years earlier, and death four years earlier than the low deprivation group. Risk of death was greatest in the high deprivation group. Conclusion The most affluent women with multiple long-term conditions were at increased risk of recorded dementia. Long-term conditions may be more life-limiting for men living in the highest level of deprivation. Competing mortality is important in studies of age-related conditions and deprivation where death may occur before the outcome of interest. Future research could quantify diagnostic recording and healthcare resource use by deprivation for people with long-term conditions to inform resource allocation and prevention planning.
DOI: 10.1093/rescon/vmag211
Language: English
Field: Medicine
Open Access status: gold
Estimated APC paid: $2,000
OpenAlex ID: W7225816308
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