| 1. |
- Gomes de Matos, Elena, et al.
(author)
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Does a Change Over All Equal a Change in All? Testing for Polarized Alcohol Use Within and Across Socio-Economic Groups in Germany
- 2015
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In: Alcohol and Alcoholism. - : Oxford University Press (OUP). - 0735-0414 .- 1464-3502. ; 50:6, s. 700-707
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Journal article (peer-reviewed)abstract
- This study aimed at testing whether drinking volume and episodic heavy drinking (EHD) frequency in Germany are polarizing between consumption levels over time. Polarization is defined as a reduction in alcohol use among the majority of the population, while a subpopulation with a high intake level maintains or increases its drinking or its EHD frequency. The polarization hypothesis was tested across and within socio-economic subgroups. Analyses were based on seven cross-sectional waves of the Epidemiological Survey of Substance Abuse (ESA) conducted between 1995 and 2012 (n = 7833-9084). Overall polarization was estimated based on regression models with time by consumption level interactions; the three-way interaction with socio-economic status (SES) was consecutively introduced to test the stability of effects over socio-economic strata. Interactions were interpreted by graphical inspection. For both alcohol use indicators, declines over time were largest in the highest consumption level. This was found within all SES groups, but was most pronounced at low and least pronounced at medium SES. The results indicate no polarization but convergence between consumption levels. Socio-economic status groups differ in the magnitude of convergence which was lowest in medium SES. The overall decline was strongest for the highest consumption level of low SES.
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| 2. |
- Gomes de Matos, Elena, et al.
(author)
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Problembewusstsein und Inanspruchnahme von Hilfe bei substanzbezogenen Problemen
- 2013
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In: SUCHT. - : Hogrefe Publishing Group. - 0939-5911 .- 1664-2856. ; 59:6, s. 355-366
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Journal article (peer-reviewed)abstract
- Aims: It was aimed to estimate 12-months prevalences of i) perception of substance-related problems among alcohol, illicit drugs and prescription drug users; ii) use of several formal and informal sources of care by individuals perceiving substance-related problems; and iii) use of professional help among individuals with a substance use disorder. Factors associated with help-seeking were assessed. Methods: Data come from the 2012 Epidemiological Survey of Substance Abuse (ESA; n = 9084; 18 to 64 years; response rate 53.6 %). DSM-IV diagnoses were assessed using the M-CIDI. Regression analyses were used to assess predictors of help-seeking. Results: Between 6 % (alcohol) and 19 % (illicit drugs) of substance users reported having experienced substance related problems. Of those, 14 % (alcohol), 33 % (illicit drugs) and 59 % (prescription drugs) sought help. With the exception of income, socio-demographic variables were not associated with help-seeking. Conclusions: Results show a clear under-treatment in individuals with substance related problems. Help-seeking seems to be mainly influenced by the severity of the substance-related disorder.
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| 3. |
- Gomes de Matos, Elena, et al.
(author)
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Trends im Substanzkonsum Jugendlicher : gibt es regionale Unterschiede?
- 2014
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In: SUCHT. - : Hogrefe Publishing Group. - 0939-5911 .- 1664-2856. ; 60:3, s. 163-172
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Journal article (peer-reviewed)abstract
- Fragestellung: Es wurde untersucht, ob auf Bundeslandebene Unterschiede im Alkohol-, Tabak- und Cannabiskonsum Jugendlicher und seiner Zeitverläufe bestehen. Methodik: Daten von 23.997 Jugendlichen aus drei Erhebungswellen (2003; 2007; 2011) der Europäischen Schülerstudie zu Alkohol und anderen Drogen (ESPAD) der 9. und 10. Klasse aus fünf Bundesländern (Bayern, Berlin, Brandenburg, Mecklenburg-Vorpommern, Thüringen) wurden deskriptiv und regressionsanalytisch ausgewertet. Ergebnisse: Länderübergreifend zeigen sich für alle drei Substanzen sinkende Konsumwerte über die Zeit. Für den Cannabiskonsum ist dieser Trend nur bis 2007 zu beobachten. Berlin weist den geringsten Alkohol- und höchsten Cannabiskonsum auf. Der Tabakkonsum ist in Brandenburg und Mecklenburg-Vorpommern am höchsten und zeigt den stärksten Rückgang in Thüringen. Schlussfolgerungen: Trotz einiger Unterschiede in den Konsumprofilen der Bundesländer sind die Trends sehr homogen. Insgesamt betrachtet sind die beobachteten Konsumparameter, die sich im europäischen Vergleich auf hohem bis mittlerem Niveau befinden, rückläufig.
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| 4. |
- Höhne, Brigit, et al.
(author)
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Patterns of concurrent alcohol, tobacco, and cannabis use in Germany : prevalence and correlates
- 2014
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In: Drugs. - : Informa UK Limited. - 0968-7637 .- 1465-3370. ; 21:2, s. 102-109
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Journal article (peer-reviewed)abstract
- Aims: This study investigated past month patterns and risk factors of alcohol, tobacco and cannabis use by level of intensity in the German general population.Methods: Data from the 2006 German Epidemiological Survey of Substance Abuse (ESA) were used. The cross-sectional random sample consisted of N = 7912 adults aged 18–64 years. The response rate was 45%. Intensive use of each substance was measured applying substance-specific cut-off points: alcohol: >20/30 g pure ethanol daily for women/men; tobacco: ≥20 cigarettes daily; cannabis: on ≥6 occasions monthly.Findings: The majority of substance users reported no intensive use of any of the three substances (77.5%) and 19.4% had used one of the three substances intensively. A total of 3.1% engaged in intensive use of multiple substances with alcohol and tobacco (2.3%) as the most prevalent pattern. A higher risk for intensive use of multiple substances was found among males, older individuals and those with a substance use disorder.Conclusions: Results of this study call for an integrated view on substance use and related disorders in prevention and treatment, taking diverse use patterns and specific needs of substance abusers into account.
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| 5. |
- Kraus, Ludwig, et al.
(author)
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Age, Period and Cohort Effects on Time Trends in Alcohol Consumption in the Swedish Adult Population 1979-2011
- 2015
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In: Alcohol and Alcoholism. - : Oxford University Press (OUP). - 0735-0414 .- 1464-3502. ; 50:3, s. 319-327
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Journal article (peer-reviewed)abstract
- Aims: In Sweden, alcohol abstention has increased over the last 20 years and consumption has recently decreased after a peak in 2004. To understand the dynamics of these trends the present study aims at estimating age, period and cohort (APC) effects on trends in alcohol use prevalence as well as overall and beverage-specific volume of drinking over the last three decades. Methods: APC analysis of seven cross-sectional surveys from 1979 to 2011 was conducted using cross-classified random effects models (CCREMs) by gender. The nationally representative samples comprised 77,598 respondents aged 16-80 years. Outcome measures were 30-day prevalence of alcohol use and overall as well as beverage-specific alcohol volume. Results: Trends in prevalence, overall and beverage-specific volume were significantly affected by APC. The period effects of prevalence and overall volume showa small decline after an increase up to the year 2005. Mean beer and wine volume levelled off after a peak in 2005 and volume of spirits drinking decreased constantly. Predicted alcohol prevalence rates in male cohorts (1945-1985) remained generally at the same level, while they declined in post-World War II female generations. Results point to high overall and beverage-specific consumption among cohorts born in the 1940s, 1950s and 1980s. Conclusions: High consuming cohorts of the 1940-1950s were key in rising consumption up to 2005. Progression through the life course of these cohorts, a decrease in prevalence and drinking volume in successive cohorts seem to have contributed to the recent downward trend in alcohol use in Sweden.
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| 6. |
- Kraus, Ludwig, et al.
(author)
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Involvement in alcohol-related verbal or physical aggression. Does social status matter?
- 2015
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In: Nordic Studies on Alcohol and Drugs. - : SAGE Publications. - 1455-0725 .- 1458-6126. ; 32:5, s. 449-463
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Journal article (peer-reviewed)abstract
- INTRODUCTION -The analyses (1) assessed the association between social status variables and aggression when controlling for volume of alcohol consumption and episodic heavy drinking (EHD), (2) tested whether social status moderates the association between volume or EHD and verbal as well as physical aggression, and (3) investigated whether EHD moderates the effect of volume on aggression. METHODS - Swedish Alcohol Monitoring Survey (2003 to 2011); N=104,316 current drinkers; response rate: 51 to 38%. Alcohol-related aggression was defined as involvement in a quarrel or physical fight while drinking. Social status was defined as the highest education, monthly income and marital status. RESULTS -The associations between social status variables and aggression showed mixed results. Verbal aggression was associated with education in males and with marital status in both genders. Physical aggression was associated with education in both genders. No associations with aggression were found for income. With few exceptions, these associations remained significant when controlling for drinking patterns; social status did not moderate the association between drinking and aggression; EHD moderated the effect of volume on physical aggression in males. CONCLUSIONS - Groups of lower educated and non-married individuals experience verbal or physical aggression over and above different levels of consumption. Individual differences in aggression vulnerability rather than differences in aggression predisposition account for higher risks of aggression in these groups.
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| 7. |
- Kraus, Ludwig, et al.
(author)
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Studiendesign und Methodik des Epidemiologischen Suchtsurveys 2012
- 2013
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In: SUCHT. - : Hogrefe Publishing Group. - 0939-5911 .- 1664-2856. ; 59:6, s. 309-320
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Journal article (peer-reviewed)abstract
- Aims: The paper gives an overview on design and sample selection, measures, realization and analyses of the 2012 Epidemiological Survey of Substance Abuse (ESA). Methods: A disproportional sample was drawn from population registers using a two-stage probability design oversampling younger birth cohorts. Different modes of administration were used (paper-and-pencil questionnaire, telephone interview, online questionnaire). Results: A total of 9 084 individuals aged 18 to 64 years participated in the survey (response rate 53.6 %). The redressement weight had an effectiveness of 67.6 %. Non-responders showed a lower prevalence of alcohol and cannabis use, but a higher prevalence of episodic heavy drinking and hypnotics use as well as a higher tobacco use quantity. Respondents in the telephone and internet mode had a lower rate of substance use than those in the paper-and-pencil mode. Conclusions: Contrary to the general trend of decreasing response rates, the ESA achieves increasing response rates over the past years due to the application of a mixed mode design. Selectivity effects are possible because of the exclusion of specific population subgroups and non-response effects.
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| 8. |
- Kraus, Ludwig, et al.
(author)
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Temporal Changes in Alcohol-Related Morbidity and Mortality in Germany
- 2015
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In: European Addiction Research. - : S. Karger AG. - 1022-6877 .- 1421-9891. ; 21:5, s. 262-272
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Journal article (peer-reviewed)abstract
- Aims: Trends in morbidity and mortality, fully or partially attributable to alcohol, for adults aged 18-64 were assessed for Germany. Methods: The underestimation of population exposure was corrected by triangulating survey data with per capita consumption. Alcohol-attributable fractions by sex and two age groups were estimated for major disease categories causally linked to alcohol. Absolute numbers, population rates and proportions relative to all hospitalizations and deaths were calculated. Results: Trends of 100% alcohol-attributable morbidity and mortality over thirteen and eighteen years, respectively, show an increase in rates of hospitalizations and a decrease in mortality rates. Comparisons of alcohol-attributable morbidity including diseases partially caused by alcohol revealed an increase in hospitalization rates between 2006 and 2012. The proportion of alcohol-attributable hospitalizations remained constant. Rates of alcohol-attributable mortality and the proportion among all deaths decreased. Conclusions: The increasing trend in mortality due to alcohol until the mid-1990s has reversed. The constant proportion of all hospitalizations that were attributable to alcohol indicates that factors such as improved treatment and easier health care access may have influenced the general increase in all-cause morbidity. To further reduce alcohol-related mortality, efforts in reducing consumption and increasing treatment utilization are needed.
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| 9. |
- Legleye, Stéphane, et al.
(author)
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Properties of the Cannabis Abuse Screening Test (CAST) in the general population
- 2015
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In: International Journal of Methods in Psychiatric Research. - : Wiley. - 1049-8931 .- 1557-0657. ; 24:2, s. 170-183
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Journal article (peer-reviewed)abstract
- This paper explores the DSM-IV latent structure of cannabis users (especially its invariance towards gender and age) and assesses the psychometric properties of the Cannabis Abuse Screening Test (CAST) by confrontation with the theoretical diagnoses [dependence and cannabis use disorders (CUD)] and the latent class structure of the DSM-IV. The random sample comprised 550 French cannabis smokers aged 15-62 years interviewed by telephone. DSM-IV diagnoses were assessed with the Munich Composite International Diagnostic Interview. Internal structures of both instruments were assessed using factor analysis and latent class analysis. Optimal CAST cutoffs were determined by sensitivity, specificity and area under the receiver operating curve (AUC). CAST and DSM-IV were unidimensional (Cronbach's =0.742 and 0.752, respectively), although a two-factor solution showed a better fit for the CAST. CAST cutoffs for screening CUD and dependence were three (AUC=0.851) and five (AUC=0.868), respectively. DSM-IV latent class structure varied only marginally in age and gender. Three classes of cannabis smokers were determined, ordered along a continuum of symptoms: non-symptomatic (61.1%), moderate (32.9%) and severe (6.0%). CAST cutoff scores for screening moderate/severe and severe were, respectively, three (AUC=0.869) and eight (AUC=0.952). Results are compared to those obtained in previous CAST studies and discussed in line with the DSM-5.
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| 10. |
- Lennon, Matthew J., et al.
(author)
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Use of Antihypertensives, Blood Pressure, and Estimated Risk of Dementia in Late Life An Individual Participant Data Meta-Analysis
- 2023
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In: JAMA NETWORK OPEN. - 2574-3805. ; 6:9
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Journal article (peer-reviewed)abstract
- IMPORTANCE The utility of antihypertensives and ideal blood pressure (BP) for dementia prevention in late life remains unclear and highly contested. OBJECTIVES To assess the associations of hypertension history, antihypertensive use, and baseline measured BP in late life (age >60 years) with dementia and the moderating factors of age, sex, and racial group. DATA SOURCE AND STUDY SELECTION Longitudinal, population-based studies of aging participating in the Cohort Studies of Memory in an International Consortium (COSMIC) group were included. Participants were individuals without dementia at baseline aged 60 to 110 years and were based in 15 different countries (US, Brazil, Australia, China, Korea, Singapore, Central African Republic, Republic of Congo, Nigeria, Germany, Spain, Italy, France, Sweden, and Greece). DATA EXTRACTION AND SYNTHESIS Participants were grouped in 3 categories based on previous diagnosis of hypertension and baseline antihypertensive use: healthy controls, treated hypertension, and untreated hypertension. Baseline systolic BP (SBP) and diastolic BP (DBP) were treated as continuous variables. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-Analyses of Individual Participant Data reporting guidelines. MAIN OUTCOMES AND MEASURES The key outcome was all-cause dementia. Mixed-effects Cox proportional hazards models were used to assess the associations between the exposures and the key outcome variable. The association between dementia and baseline BP was modeled using nonlinear natural splines. The main analysis was a partially adjusted Cox proportional hazards model controlling for age, age squared, sex, education, racial group, and a random effect for study. Sensitivity analyses included a fully adjusted analysis, a restricted analysis of those individuals with more than 5 years of follow-up data, and models examining the moderating factors of age, sex, and racial group. RESULTS The analysis included 17 studies with 34 519 community dwelling older adults (20 160 [58.4%] female) with a mean (SD) age of 72.5 (7.5) years and a mean (SD) follow-up of 4.3 (4.3) years. In the main, partially adjusted analysis including 14 studies, individuals with untreated hypertension had a 42% increased risk of dementia compared with healthy controls (hazard ratio [HR], 1.42; 95% CI 1.15-1.76; P =.001) and 26% increased risk compared with individuals with treated hypertension (HR, 1.26; 95% CI, 1.03-1.53; P =.02). Individuals with treated hypertension had no significant increased dementia risk compared with healthy controls (HR, 1.13; 95% CI, 0.99-1.28; P =.07). The association of antihypertensive use or hypertension status with dementia did not vary with baseline BP. There was no significant association of baseline SBP or DBP with dementia risk in any of the analyses. There were no significant interactions with age, sex, or racial group for any of the analyses. CONCLUSIONS AND RELEVANCE This individual patient data meta-analysis of longitudinal cohort studies found that antihypertensive usewas associated with decreased dementia risk compared with individuals with untreated hypertension through all ages in late life. Individuals with treated hypertension had no increased risk of dementia compared with healthy controls.
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| 11. |
- Pabst, Alexander, et al.
(author)
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Decomposing social inequalities in alcohol consumption in Germany 1995-2015 : an age-period-cohort analysis
- 2019
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In: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 114:8, s. 1359-1368
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Journal article (peer-reviewed)abstract
- Background and aims Previous research indicates that compared with individuals with lower socio-economic status (SES), individuals in higher SES groups are more often drinkers but those who drink report drinking smaller amounts more frequently. We aimed to decompose trends in self-reported alcohol consumption in Germany into age, period and birth cohort effects and examine whether these effects varied by SES. Design Age-period-cohort (APC) analysis using data from eight waves of the cross-sectional German Epidemiological Survey of Substance Abuse (ESA) collected between 1995 and 2015. Setting Germany. Participants The analytical sample included n=65821 individuals aged 18-64years reporting alcohol use within the last 30days. Measurements Alcohol measures included drinking prevalence, alcohol volume and prevalence of episodic heavy drinking (EHD). Educational attainment was used as an indicator of SES. A series of generalized linear and logistic regression models, including both main and interaction effects of age, period and cohort with SES, were estimated. Findings Regression models revealed significant interactions between APC effects and SES on two alcohol consumption measures. Higher SES was consistently associated with drinking prevalence across age (P<0.001), period (P=0.016) and cohort (P=0.016), and with volume of drinking in younger cohorts (P=0.002) and 50+-year-olds (P=0.001). Model results were inconclusive as to whether or not APC effects on EHD prevalence differed by SES. Conclusions In Germany, there are positive associations between socio-economic status and alcohol consumption during the life-course, over time and among birth cohorts. Three groups appear vulnerable to risky drinking: high socio-economic status young birth cohorts who drink high average quantities, low socio-economic status young birth cohorts who show a risky drinking pattern and high socio-economic status adults in their 50s and older who increase their drinking volume beyond that age.
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| 12. |
- Pabst, Alexander, et al.
(author)
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Direct and indirect effects of alcohol expectancies on alcohol-related problems
- 2014
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In: Psychology of Addictive Behaviors. - : American Psychological Association (APA). - 0893-164X .- 1939-1501. ; 28:1, s. 20-30
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Journal article (peer-reviewed)abstract
- This study investigates pathways from alcohol outcome expectancies to alcohol-related problems (ARPs), considering alcohol volume and episodic heavy drinking (EHD) as potential mediators. It is further examined whether these pathways vary by age. The population-based sample comprised 6,823 individuals aged 18 to 64 years reporting alcohol use in the past year. Direct and indirect effects of five alcohol expectancies (social assertiveness, tension reduction, sexual enhancement, cognitive impairment, aggression) and alcohol use (average daily intake, EHD) on a latent measure of ARPs (six items of the Alcohol Use Disorders Identification Test) were investigated. A multiple-group structural equation model with three age groups (18 to 24, 25 to 44, 45 to 64 years) was examined. In individuals aged 18 to 24 years, social assertiveness expectancies were positively associated with average intake and EHD, which in turn were associated with more ARPs. In addition, expectancies related to cognitive impairment and aggression were directly linked to more ARPs without mediation in this age group. In individuals aged 25 years and older, tension reduction expectancies were associated with more ARPs through increased average intake. In contrast, high scores on cognitive impairment were associated with lower average intake and in turn with fewer ARPs. Challenging expectancies of sociability in young and expectancies of relaxation in mid adulthood might help decrease high-risk drinking and subsequently ARPs. Considering negative alcohol expectancies may help to identify younger individuals at high risk for ARPs, even if they have not previously exhibited repeated excessive drinking.
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| 13. |
- Pabst, Alexander, et al.
(author)
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Substanzkonsum und substanzbezogene Störungen in Deutschland im Jahr 2012
- 2013
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In: SUCHT. - : Hogrefe Publishing Group. - 0939-5911 .- 1664-2856. ; 59:6, s. 321-331
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Journal article (peer-reviewed)abstract
- Aims: To examine prevalences, patterns and disorders associated with the use of alcohol, tobacco, illegal drugs and prescription drugs. Methods: The sample of the 2012 Epidemiological Survey of Substance Abuse (ESA) was randomly drawn from population registers and consisted of 9 084 individuals aged 18 to 64 years. A mixed-mode design including questionnaires, telephone and Internet interviews was applied. The response rate was 53.6 %. Results: Based on the past 30 days 57.3 % of respondents reported low-risk alcohol consumption whereas 14.2 % reported risky consumption. Overall, 30.2 % reported having smoked within this period. The 12-months prevalence of illegal substance use was 4.5 % for cannabis, 0.8 % for cocaine and 0.7 % for amphetamines. Analgesics were the most prevalent prescription drugs used within the past 12 months (61.9 %). Rates of DSM-IV substance dependence were estimated at 3.4 % for alcohol, 10.8 % for tobacco, 0.5 % for cannabis, 0.2 % for cocaine, 0.1 % for amphetamines and 3.4 % for analgesics. Conclusions: The high prevalence of substance use disorders associated with alcohol and tobacco emphasize the urgency of implementing effective prevention measures. Disorders associated with prescription drugs should be given more attention.
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| 14. |
- Piontek, Daniela, et al.
(author)
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Komorbide Substanzstörungen in der erwachsenen Allgemeinbevölkerung
- 2013
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In: SUCHT. - : Hogrefe Publishing Group. - 0939-5911 .- 1664-2856. ; 59:6, s. 347-354
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Journal article (peer-reviewed)abstract
- Aims: It is aimed to assess homotypic comorbidity of substance use disorders in a representative sample of the adult general population in Germany. Methods: Data from the 2012 Epidemiological Survey of Substance Abuse are used. Based on a two-stage probability sampling, a total of n = 9 084 individuals participated (net response rate 53.6 %). Substance use disorders according to DSM-IV for alcohol, tobacco, cannabis, cocaine, amphetamines, analgesics, hypnotics and tranquilizers were assessed using the Munich Composite International Diagnostic Interview (M-CIDI). Results: Multiple diagnoses (abuse and/or dependence) were prevalent in 6.6 % of the sample. The percentage of comorbid substance use disorders was highest among those with a diagnosis related to cannabis, hypnotics and cocaine. Risk factors for at least one and more than one substance use disorders were male gender, younger age, lower educational level, being single or divorced and non-German citizenship. Conclusions: A relevant proportion of the general population in Germany is affected by more than one clinical diagnosis related to substance use. Further epidemiological research is necessary to describe this population of high risk.
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| 15. |
- Thrul, Johannes, et al.
(author)
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The impact of school nonresponse on substance use prevalence estimates – Germany as a case study
- 2016
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In: International journal on drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 27, s. 164-172
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Journal article (peer-reviewed)abstract
- BACKGROUND:The European School Survey Project on Alcohol and Other Drugs (ESPAD) is a survey study that collects comparable data on substance use of students aged 15-16 years old in European countries. The present study aims at investigating the impact of school refusal to participate in ESPAD on substance use prevalence estimates.METHODS: Data came from the 2007 German ESPAD study; the sample consisted of 12,246 students in 552 schools within seven German federal states. A simulation approach was used in order to study the effects of systematic exclusion of participating schools on prevalence estimates of key ESPAD outcomes including the use of tobacco, alcohol, cannabis, and other illegal drugs.RESULTS: The systematic exclusion of schools based on city-, school-, and class size, school environment, and schools' substance use policies resulted in significant changes in prevalence estimates in 23 of 25 examined combinations of selection criterion and outcome. Yet, these effects were small, with differences remaining below three percentage points around the original estimates.CONCLUSIONS: This simulation approach suggests that nonparticipation of schools in surveys on students' substance use in Germany does not largely affect the validity of resulting prevalence estimates. Even a reduced number of schools may be sufficient to gain valid prevalence figures.
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| 16. |
- Van Asbroeck, Stephanie, et al.
(author)
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Lifestyle and incident dementia: A COSMIC individual participant data meta-analysis
- 2024
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In: ALZHEIMERS & DEMENTIA. - 1552-5260 .- 1552-5279. ; 20:6, s. 3972-3986
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Journal article (peer-reviewed)abstract
- INTRODUCTIONThe LIfestyle for BRAin Health (LIBRA) index yields a dementia risk score based on modifiable lifestyle factors and is validated in Western samples. We investigated whether the association between LIBRA scores and incident dementia is moderated by geographical location or sociodemographic characteristics. METHODSWe combined data from 21 prospective cohorts across six continents (N = 31,680) and conducted cohort-specific Cox proportional hazard regression analyses in a two-step individual participant data meta-analysis. RESULTSA one-standard-deviation increase in LIBRA score was associated with a 21% higher risk for dementia. The association was stronger for Asian cohorts compared to European cohorts, and for individuals aged <= 75 years (vs older), though only within the first 5 years of follow-up. No interactions with sex, education, or socioeconomic position were observed. DISCUSSIONModifiable risk and protective factors appear relevant for dementia risk reduction across diverse geographical and sociodemographic groups. Highlights A two-step individual participant data meta-analysis was conducted. This was done at a global scale using data from 21 ethno-regionally diverse cohorts. The association between a modifiable dementia risk score and dementia was examined. The association was modified by geographical region and age at baseline. Yet, modifiable dementia risk and protective factors appear relevant in all investigated groups and regions.
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