Overall and Sex-Specific Risk Factors for Subjective Cognitive Decline: Findings From the 2015–2018 Behavioral Risk Factor Surveillance System Survey

Overall and Sex-Specific Risk Factors for Subjective Cognitive Decline: Findings From the 2015–2018 Behavioral Risk Factor Surveillance System Survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Overall and Sex-Specific Risk Factors for Subjective Cognitive Decline: Findings From the 2015–2018 Behavioral Risk Factor Surveillance System Survey Karen Schliep, Lily Gu, Kristine Lynch, Michelle Sorweid, Michael Varner, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1111688/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Apr, 2022 Read the published version in Biology of Sex Differences → Version 1 posted 4 You are reading this latest preprint version Abstract Background Prior research indicates that at least 35% of Alzheimer’s disease and related dementia risk may be amenable to prevention. Subjective cognitive decline is often the first indication of preclinical dementia, with the risk of subsequent Alzheimer’s disease in such individuals being greater in women than men. We wished to understand how modifiable factors are associated with subjective cognitive decline, and whether differences exist by sex. Methods Data were collected from men and women (45 years and older) who completed the U.S. Behavioral Risk Factor Surveillance System Cognitive Decline Module (2015–2018), n =216,838. We calculated population attributable fractions for subjective cognitive decline, stratified by sex, of the following factors: limited education, deafness, social isolation, depression, smoking, physical inactivity, obesity, hypertension, and diabetes. Our models were adjusted for age, race, income, employment, marital and Veteran status, and accounted for communality among risk factors. Results The final study sample included more women (53.7%) than men, but both had a similar prevalence of subjective cognitive decline (10.6% of women versus 11.2% of men). Women and men had nearly equivalent overall population attributable fractions to explain subjective cognitive decline (39.7% for women versus 41.3% for men). The top three contributing risk factors were social isolation, depression, and hypertension, which explained three-quarters of the overall population attributable fraction. Conclusions While we did not identify any differences in modifiable factors between men and women contributing to subjective cognitive decline, other factors including reproductive or endocrinological health history or biological factors that interact with sex to modify risk warrant further research. Preventive Medicine Internal Medicine Epidemiology Subjective Cognitive Decline Dementia Cognitive Dysfunction Behavioral Risk Factor Surveillance System Risk Factors Sex Factors Figures Figure 1 Highlights Subjective Cognitive Decline (SCD) is one of the earliest noticeable symptoms of Alzheimer’s disease and related dementias. While there is no current cure for dementia, research indicates that at least 35% of dementia risk may be modifiable by decreasing exposures years or even decades before cognitive decline becomes clinically evident. Prior research has shown that the risk of dementia in individuals with cognitive impairment is higher in women than in men, as is the overall risk of dementia. Among a nationally representative population of over 200,000 adults, ages 45 years and older, SCD prevalence was 11% for both women and men. Women and men also had nearly equivalent overall population attributable fractions to explain subjective cognitive decline (39.7% for women versus 41.3% for men). The top three contributing risk factors for both women and men were social isolation, depression, and hypertension, which explained three-quarters of the overall population attributable fraction. Background Life expectancy in developed countries is rising, with an estimated 50% of children born in 2000 expected to live to 100 years and beyond ( 1 ).This extended life expectancy is a public health success story; however, a consequence of this success includes higher rates of cognitive impairment and dementia, estimated to triple by 2050 ( 2 ). Subjective cognitive decline (SCD) is the self-reported experience of worsening or more frequent confusion or memory loss. It is considered to be one of the earliest noticeable symptoms of preclinical Alzheimer’s disease (AD) ( 3 ), although as illness progresses awareness of deficits decreases ( 4 ). Several studies have shown that individuals with SCD have increased risk of subsequent objective cognitive decline including mild cognitive impairment and AD ( 5 – 7 ). While there is no current cure for dementia, research indicates that at least 35% of dementia risk may modifiable by decreasing exposures years or even decades before cognitive decline becomes clinically evident ( 8 – 10 ). Key modifiable factors, identified through systematic reviews and meta-analyses, include low educational attainment, hearing loss, social isolation, depression, smoking, physical inactivity, obesity, hypertension, and diabetes ( 8 – 10 ). These modifiable factors, and their relationship with cognitive impairment and dementia, vary based on sex, geography, and other factors. Since previous studies have shown that the risk of subsequent AD in individuals with cognitive impairment is higher in women than in men ( 11 ), as is the overall risk of dementia ( 12 , 13 ), an improved understanding of sex-specific differences in relation to how modifiable factors may impact cognitive dysfunction risk is needed. Identifying early risk factors for subsequent cognitive dysfunction is challenging. Research to date is largely derived from clinical rather than population-based cohorts and have focused on patients already presenting with dementia ( 14 ). The Behavioral Risk Factor Surveillance System (BRFSS), a United States (US) nationally representative population-based survey administered by the Centers for Disease Control and Prevention, finalized its Cognitive Decline Module that captures SCD in 2015 ( 15 ). The objective for this study was to use 2015–2018 BRFSS data to determine the population attributable fraction (PAF) of nine known risk factors for SCD, with a focus on sex-specific disparities. Methods Study population All men and women aged 45 years and older who completed the 2015–2018 BRFSS survey, inclusive of the Cognitive Decline Module, were considered for this study. The purpose of the BRFSS, which began in 1984, is to assess health status and health behaviors of the US population based on self-reported responses ( 15 ). The purpose of the Cognitive Decline Module, which was offered for the first time in 2011 and finalized and approved in 2015, is to monitor SCD and its associated effect or burden in the population ( 16 ). The Cognitive Decline Module is an optional component offered to states who can elect or decline to include it in the BRFSS survey. Data are weighted by the Centers for Disease Control and Prevention to be representative of the population on a number of demographic characteristics, including sex, age, race, education, marital status, home ownership, phone ownership (landline telephone, cellular telephone or both) and sub-state region. From 2015–2018, all 50 states plus the District of Columbia and Puerto Rico have administered the Cognitive Decline Module at least once. Measure for cognitive decline SCD was determined based on a binary ‘Yes’ or ‘No’ response to the first question of the Cognitive Decline Module: ‘During the past 12 months, have you experienced confusion or memory loss that is happening more often or is getting worse?’ Individuals who responded ‘Yes’ or ‘No’ to this question were included in the analysis ( n =216,838), while those who answered ‘Don’t Know/Not Sure’ ( n =1,501) or ‘Refused’ ( n =437) were excluded. Risk factors for cognitive decline For comparability with prior research ( 9 ), we examined nine key modifiable risk factors for dementia, which were selected from a list of risk factors provided by the United Kingdom National Institute of Health and Care Excellence and the US National Institutes of Health ( 17 ) ( 18 ). Nine binary risk factors were derived from standard BRFSS self-reported questions and defined as ‘Yes’ or ‘No’ variables ( 9 ). Prior research has documented the reliability and validity of the BRFSS questionnaire ( 19 , 20 ). We excluded Refused, Don’t Know, Unsure, Missing, and Unknown responses. Some risk factors were not available in every year of BRFSS from 2015–2018 (Table 1 ) Statistical analysis Due to the complex survey design of BRFSS, statistical analyses incorporated clustering ( PSU ), stratification ( STSTR ), and weighting ( LLCPWT ), following established Centers for Disease Control and Prevention methodology, which uses iterative proportional fitting weighting since 2011 ( 21 ). All results provided in this study were weighted estimates adjusted for disproportionate non-response, non-coverage, and other sampling bias. Descriptive statistics of respondent demographics were calculated for the total population, as well as by sex. For each risk factor, relative risk (RR) and 95% confidence intervals (CI) for SCD were estimated, both unadjusted and adjusted for demographic factors including age, race, income, employment, marital status, and Veteran status. Given that age of a respondent at the time they completed the survey may act as an effect modifier between sex or modifiable risk factors and SCD, we ran our analyses stratified by age (<65 years versus ≥65 years). Principal component analysis based on a weighted tetrachoric correlation matrix of the nine risk factors was performed to calculate communality of each risk factor, which refers to the total amount of shared variance among risk factors. Due to current limitations in statistical software, stratification and clustering were not incorporated in the calculations for communality. The PAF for each risk factor and all risk factors combined (overall PAF) were calculated using formulas ( See Additional file 1 ) provided by Livingston et al . and Mukadam et al . ( 8 , 9 , 22 ), with weighting to account for communality, as well as adjustment for demographic factors (WaPAF). All statistical analyses were conducted using SAS 9.4 (Cary, North Carolina, USA). Results Population characteristics The study consisted of more women (53.7%) than men, with more women than men aged 70 years or older (Table 2 ). Three-quarters of the study population were non-Hispanic white, 11.1% were non-Hispanic black, 8.6% were Hispanic, and 5.0% were either non-Hispanic Asian/Native Hawaiian/Pacific Islander, non-Hispanic American Indian/Alaskan Native, or non-Hispanic individuals of other or multiple races. Compared to women, men were more likely to be younger at the time of interview, married, employed, have a higher income, and have Veteran status. Women were more than twice as likely to be widowed as men. Overall, 10.9% of adults reported experiencing symptoms of SCD, with slightly more men (11.2%) compared to women (10.6%) reporting SCD. The relationship between respondent’s age and report of SCD differed between men and women. For men, a near linear relationship between age and probability of SCD was found. For women, the relationship was more “S” shaped with women ages 50–54 showing a higher probability of SCD compared to women ages 60–64 or 70–74 ( See Additional file 2 ) Relative risk for subjective cognitive decline Among all adults, exposure to any of the nine identified risk factors was positively associated with the risk of SCD in the unadjusted models (Table 3 ) and after adjusting for age, race, income, employment status, marital status, and Veteran status (Table 4 ). The leading risk factors included depression, social isolation, and deafness, where adults with depressive disorders were three times more likely to have SCD than adults without (adjusted risk ratio (aRR): 3.12, 95% CI: 2.95, 3.29), and adults who did versus did not experience social isolation or deafness carried more than double the risk of SCD (aRR: 2.46, 95% CI: 2.15, 2.77; aRR: 2.01, 95% CI: 1.82, 2.19, respectively). Adults who were physically inactive (aRR: 1.32, 95% CI: 1.25, 1.39), had hypertension (aRR: 1.28, 95% CI: 1.20, 1.36) or diabetes (aRR: 1.28, 95% CI: 1.21, 1.35), or currently smoked (aRR: 1.20, 95% CI: 1.12, 1.27) carried a 20–32% increased risk for SCD compared to their non-exposed counterparts. Adults who were obese (aRR: 1.14, 95% CI: 1.08, 1.19) or had limited education (aRR: 1.12; 95% CI: 0.99, 1.26) carried a 12–14% increased risk compared to their non-exposed counterparts. Younger adults (< 65 years), compared to older adults (≥ 65 years), had significantly greater risk for SCD from depression (aRR: 3.34, 95% CI: 3.10, 3.59; vs. aRR: 2.72, 95% CI: 2.48, 2.95), smoking (aRR: 1.24, 95% CI: 1.15, 1.33; vs. aRR: 0.98, 95% CI: 0.86, 1.11), and hypertension (aRR: 1.38, 95% CI: 1.26, 1.49; vs. aRR: 1.10, 95% CI: 1.01, 1.20) ( See Additional files 3 and 4 ). These differences between age groups were mostly derived from sex-specific discrepancies. For instance, women aged < 65 had greater risk for SCD from smoking (aRR: 1.37, 95% CI 1.24, 1.50) compared to women aged ≥ 65 (aRR: 1.01, 95% CI 0.83, 1.19). Men aged ≤ 64, compared to men aged ≥ 65, had greater risk for SCD from depression (aRR: 3.63, 95% CI 3.20, 4.06; vs. aRR: 2.55, 95% CI 2.23, 2.86) and hypertension (aRR: 1.51, 95% CI 1.31, 1.71; vs. aRR: 1.06, 95% CI 0.93, 1.19). However, among adults aged ≥ 65, women had greater risk for SCD from depression (aRR: 3.52, 95% CI: 3.12, 3.92) compared to men (aRR: 2.55, 95% CI: 2.23, 2.86). Population attributable fraction of risk factors Collectively, the nine risk factors in this study were estimated to be attributed to 74.1% of all cases of SCD in the population, after adjusting for age, race, income, employment status, marital status, and Veteran status (Table 3 ). After accounting for the shared variance among risk factors, the hypothetical elimination of all exposures predicted a reduction in SCD by over one-third (WaPAF 38.3%). Women and men had nearly equivalent overall WaPAFs to explain SCD (39.7% for women compared to 41.3% for men). Similar findings existed among men and women of different age groups, with a WaPAF of 41.9% observed among adults <65 and a WaPAF of 36.7% among adults ≥65 (See Additional files 3 and 4). Nearly 38% of SCD cases in the population could be attributable to social isolation (WaPAF 14.4%), while 25% could be attributable to depression (WaPAF 9.5%) and 11% to hypertension (WaPAF 4.2%). Physical inactivity (WaPAF 3.0%), deafness (WaPAF 3.0%), diabetes (WaPAF 1.6%), obesity (WaPAF 1.4%), smoking (WaPAF 1.0%) and limited education (WaPAF 0.2%) accounted for the remaining 27% PAF for SCD (Figure 1 a). Depression, smoking, diabetes, and limited education contributed more to SCD in women than men, while social isolation, hypertension, physical inactivity, obesity, and deafness, contributed more to SCD in men than women (Table 3 ). However, there was little difference in regards to the magnitude of contributing factors between sexes ( Figure 1bc ). Among adults aged 65 and older, limited educational attainment no longer contributed to SCD risk among women (WaPAF 0.00%), while smoking no longer contributed to SCD risk among men (WaPAF 0.00%) (See Additional file 4). Discussion Main findings In this large representative sample of US adults aged 45 and older, we found that more than 1 in 10 survey respondents reported SCD and nearly 40% of SCD could be attributed to known modifiable factors. Overall, the top three contributing risk factors were social isolation, depression and hypertension, which contributed three-quarters of the adjusted PAF for SCD. Physical inactivity, deafness, diabetes, obesity, smoking, and limited education contributed the remaining quarter. Little difference between women and men was found for the attributable proportion of SCD that may be amenable to prevention. However, further research is warranted for exploring other modifiable factors that have recently been shown to be associated with cognitive decline, including heavy alcohol consumption, traumatic brain injury, and air pollution ( 8 ), in addition to reproductive health history ( 23 ), which may contribute to SCD risk and sex-specific SCD risk. Significance of results Our study is novel in using data from a US nationally representative population-based survey to determine modifiable risk factors for subjective cognitive decline. Prior studies have used pooled estimates from meta-analyses ( 8 – 10 ) or smaller prospective cohorts in other countries ( 24 , 25 ) to calculate PAFs for dementia. While epidemiologic evidence has shown that SCD significantly increases risk for later mild cognitive impairment and dementia, the majority of individuals with SCD (which can be caused by several medical conditions) will not go on to develop cognitive decline ( 26 ). Current research, for which our findings may help inform, is focused on understanding what characteristics cause some individuals with SCD to go on to develop dementia compared to others who remain cognitively normal ( 26 ). Despite different cognitive outcome assessments and study designs, we found it reassuring that our results for SCD were comparable to prior research for dementia outcomes, which demonstrate between 35% and 50% of dementia risk may be amenable to prevention ( 8 – 10 , 24 , 25 ). Given that we had limited data for deafness, hypertension and most notably for social isolation, we advise caution in interpreting our findings as to what factors contribute the most to SCD. While our findings are in line with past research on importance of hypertension and hearing loss in relation to cognitive health, there is limited research on social isolation. Further research with gold-standard methods to capture social isolation and with complete data is needed before definitive conclusions can be made. Comparison with other studies The Lancet Commission on Dementia Prevention, Intervention, and Care reported in 2017 that 35% of dementia cases could theoretically be preventable by eliminating the following risk factors: limited education in early life (8%), mid-life hearing loss (9%), hypertension (2%), obesity (1%), later life smoking (5%), depression (4%), physical inactivity (3%), social isolation (2%) and diabetes (1%) ( 9 ). In a recently published 2020 report update, the Commission added three additional modifiable factors—excessive alcohol consumption (>21 units/week), traumatic brain injury, and air pollution—which has raised the theoretical proportion of worldwide dementia that could be prevented to 40% ( 8 ). While we determined a similar attributable fraction as the 2017 Commission (38% vs. 35%, respectively), using the same modifiable factors and methodology (WaPAF), the relative contributions of the modifiable factors differed. The Commission reported that hearing loss, limited education, and smoking contributed to over half the attributable fraction for dementia, while in the BRFSS, we found that social isolation, depression, and hypertension were responsible for nearly three-quarters of the attributable fraction for SCD. These differences may be attributed to many factors including differences in population characteristics (e.g., clinical versus population-based samples) and the fact that the Commission assessed modifiable factors for dementia while we were assessing modifiable factors for SCD, a potential early indicator of subsequent dementia. Additionally, while we used similar methodology for calculating the PAFs for modifiable factors as the Lancet Commission including consideration of confounding factors for RRs and accounting for communality of risk factors ( 8 , 9 ), our calculation of RR estimates for modifiable factors differed greatly from that of the Commission. They extensively reviewed the international literature conducted predominately over the past two decades on each contributing risk factor and either applied previously published pooled RRs or calculated pooled RRs based on their own meta-analysis. Furthermore, to calculate communality, they used a representative sample of over 10,000 UK community-dwelling adults ( 9 ). For our analysis on SCD, we used a single data source within the US to calculate both our adjusted RRs and communality of risk factors within a recent specified time frame (2015–2018). Using similar methodology to the Commission in identifying aRRs for potentially modifiable risk factors for Alzheimer's disease via systematic reviews and meta-analyses, another prior study found an overall adjusted PAF of 54.1% for Alzheimer's disease ( 10 ). Given that communality was not considered, this estimate would be equivalent to the Commission’s unweighted PAF of 88.8% or our finding in the BRFSS of 74.1%. Additionally, this prior study assessed seven factors (low education, smoking, physical inactivity, depression, mid-life hypertension, diabetes and mid-life obesity) ( 10 ), so comparing impact of the additional two factors in the Commission ( 9 ) and our study—hearing loss and social isolation—is not possible. It is notable that while limited education contributed to the highest population attributable risk in the global assessment (19.1%), and backed up by other European prospective cohort studies ( 23 , 24 ), it dropped to second to last (PAR 7.3%) in the US assessment. This demonstrates the importance of calculating country-specific attributable proportions for dementia and cognitive impairment. Regarding sex differences in modifiable factors for SCD, we, along with a prior study using data from the 2011 BRFSS SCD module ( 27 ) found no appreciable differences between men and women in prevalence or risk factors for SCD. Findings on sex differences in AD and related dementia risk is also limited; and at present equivocal ( 12 , 28 ). For example, research from a subset of the Framingham Heart Study (1975–2009) found lifetime risk of Alzheimer’s disease and related dementia at age 45 to be 1 in 5 in women compared to 1 in 10 in men ( 12 ), while research from the Rochester Epidemiology Project (1985–1989) found no difference in risk between men and women ( 28 ). Differences in these two studies highlight the need to consider study population characteristics when assessing sex-specific Alzheimer’s disease and related dementia risk. Furthermore, even if incidence or prevalence of SCD or dementia is equal in men and women in any given population, as we found in the BRFSS data, risk factors for SCD and dementia may still differ ( 28 ). Sex differences for AD and dementia have been found for depression, sleep apnea, low education, marital status, and reproductive events unique to each sex (such as pregnancy and menopause for women and androgen-deprivation therapy for men) ( 23 , 28 ). Clearly, despite our finding of no appreciable differences in contributing factors for SCD between men and women, more research is warranted assessing other risk factors that could not be assessed in this analysis. Strengths and Limitations Our study addressed prior gaps in the literature, including being one of the first studies to use recent data from a large population-based survey to assess PAFs of modifiable factors for SCD, while considering correlation between risk factors. This differs from other studies, which have focused on Alzheimer’s disease or all-cause dementia, versus SCD, or that have relied on meta-analyses for adjusted RR estimates ( 8 – 10 ), or which rely on unique cohorts from other countries which may not be generalizable to the US population ( 24 , 25 ). Despite our unique contribution, our study had several limitations. First, information for SCD and risk factors was based on self-reported data, which is susceptible to measurement error, especially since people experiencing cognitive decline are more likely to have anosognosia or be unaware of their deficits ( 29 ). While anosognosia is associated with disease severity ( 30 ) and consequently individuals with SCD are less likely to be susceptible to anosognosia than individuals with Alzheimer’s disease or other dementia, we realize that anxiety around cognitive performance may still result in differential misclassification of the outcome or differential selection related to participants with SCD skipping over the cognitive questions. Additionally, individuals with severe SCD are most likely excluded since BRFSS respondents who complete the survey are deemed by themselves or another household member to be mentally fit to respond to the survey ( 31 ). While the BRFSS finalized 2015 Cognitive Decline module includes only one question to determine SCD (with an additional 5 questions to assess whether SCD affects respondent’s functioning), further research using multi-item measures of SCD ( 32 ) would help differentiate how modifiable factors may impact various SCD subtypes (e.g., amnestic versus non-amnestic SCD or single-domain versus multiple-domain SCD) ( 33 ). While self-report of cognitive decline and risk factors for cognitive decline have their limitations, they also have their strengths. For example, we used BRFSS questions that were better aligned with perceived social isolation rather than risk factors for social isolation, such as number of people living in household. This is important since perceived social isolation is usually more qualitative than quantitative in nature ( 34 ). Another limitation of this study is the cross-sectional nature of the BRFSS survey, limiting ability to distinguish cause and effect. Only limited education, as defined, would precede SCD. To best assess risk, prospective cohort studies following young adults longitudinally, capturing modifiable factors over time and subsequent SCD are warranted. Longitudinal studies would also allow better capture of time-varying confounders or modifiers that may impact risk factors and SCD, such as personality factors or depression ( 35 , 36 ). Finally, we had incomplete data on hypertension, deafness, and most notably social isolation; and failed to include newly reported modifiable risk factors, including heavy alcohol consumption, traumatic brain injury, or air pollution, as reported in the 2020 by the Lancet Commission ( 8 , 9 ). Other potentially modifiable factors known to differ between men and women in relation to AD or related dementia risk, inclusive of cardiometabolic and reproductive health factors, also warrant further research. Conclusion In summary, in this large nationally representative US sample of community-dwelling adults, we found that roughly 1 in 10 reported SCD with nearly 40% attributable to modifiable factors, including social isolation, depression, and hypertension, which explained nearly three-quarters of the attributable fraction. Further research, ideally in longitudinal cohorts assessing time-varying risk factors and SCD from early to late adulthood, is needed before definitive conclusions can be made. However, given recent findings from the SPRINT MIND trial showing that intensive blood pressure control can significantly reduce the risk of mild cognitive impairment ( 37 ), our findings documenting the high attributable fraction of hypertension in relation to SCD in a community-based sample suggest that blood pressure control may mitigate risk of SCD in over 50% of the US population over age 45. Additionally, prior research suggesting the positive link between social relationships and cognitive functioning ( 38 ) or long-term selective serotonin reuptake inhibitor treatment for depression and delayed progression to dementia ( 39 ) suggest early intervention strategies may have a significant impact on reducing or at least delaying cognitive impairment within the US population. While our study indicated minimal difference in prevalence or risk factors for SCD between sexes, further research assessing reproductive and endocrinological health history in addition to biological factors that interact with sex-related factors that can be modified ( 13 ) should be conducted within population-based samples. Abbreviations AD: Alzheimer’s disease; aRR: adjusted relative risk; BRFSS: Behavioral Risk Factor Surveillance System; CI: confidence interval; RR: relative risk; PAF: population attributable fraction; SCD, subjective cognitive decline; WaPAF: weighted adjusted population attributable fraction. Declarations Ethics approval and consent to participate: The Institutional Review Board (IRB) of the researchers’ institution recognize that the analysis of de-identified, publicly available data does not constitute human subjects research as defined in federal regulations, and as such does not require IRB review. Human subjects review was not sought nor received. Consent for publication: Not applicable. Availability of data and materials: BFFSS is a publically available dataset overseen by the Centers for Disease Control and Prevention. Survey data and documentation is available at https://www.cdc.gov/brfss/data_documentation/index.htm . Competing interests: The authors have no conflicts of interest relevant to this study to disclose. Funding: Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Number K01AG058781. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Authors' contribution: All authors assisted in the development of the research question and study design. LYG completed the data analyses, and KCS wrote the original manuscript draft. All authors contributed to the manuscript preparation and revision. All authors reviewed, edited, and approved the final manuscript. Acknowledgements : Initial findings from this project were presented as an oral presentation at the Sex, Gender, and Women’s Health Across the Lifespan, Virtual Symposium. 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Mondragón JD, Maurits NM, De Deyn PP. Functional neural correlates of anosognosia in mild cognitive impairment and alzheimer’s disease: a systematic review. Neuropsychol Rev. 2019:1–27. Prevention CfDCa. Centers for Disease Control and Prevention, Healthy Aging Program Georgia, Atlanta, 2015. Cognitive decline module – behavioral risk factor surveillance system (BRFSS) 2015 [Available from: http://www.cdc.gov/aging/healthybrain . Accessed November 20, 2021. Gifford KA, Liu D, Romano R, 3rd, Jones RN, Jefferson AL. Development of a subjective cognitive decline questionnaire using item response theory: a pilot study. Alzheimers Dement (Amst). 2015;1:429–39. Diaz-Galvan P, Ferreira D, Cedres N, Falahati F, Hernandez-Cabrera JA, Ames D, et al. Comparing different approaches for operationalizing subjective cognitive decline: impact on syndromic and biomarker profiles. Sci Rep. 2021;11:4356. Hawkley LC, Capitanio JP. Perceived social isolation, evolutionary fitness and health outcomes: a lifespan approach. Philos Trans R Soc Lond B Biol Sci. 2015;370. Munoz N, Goma IFM, Valero S, Rodriguez-Gomez O, Sanabria A, Perez-Cordon A, et al. Personality Factors and Subjective Cognitive Decline: The FACEHBI Cohort. Behav Neurol. 2020;2020:5232184. Kim D, Wang R, Kiss A, Bronskill SE, Lanctot KL, Herrmann N, et al. Depression and Increased Risk of Alzheimer's Dementia: Longitudinal Analyses of Modifiable Risk and Sex-Related Factors. Am J Geriatr Psychiatry. 2021 Sep;29:917–926. Group SMIftSR, Williamson JD, Pajewski NM, Auchus AP, Bryan RN, Chelune G, et al. Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia: A Randomized Clinical Trial. JAMA. 2019;321:553–61. Kelly ME, Duff H, Kelly S, McHugh Power JE, Brennan S, Lawlor BA, et al. The impact of social activities, social networks, social support and social relationships on the cognitive functioning of healthy older adults: a systematic review. Syst Rev. 2017;6:259. Bartels C, Wagner M, Wolfsgruber S, Ehrenreich H, Schneider A, Alzheimer's Disease Neuroimaging I. Impact of SSRI Therapy on Risk of Conversion From Mild Cognitive Impairment to Alzheimer's Dementia in Individuals With Previous Depression. Am J Psychiatry. 2018;175:232–41. Tables Table 1: Modifiable risk factors obtained from BRFSS, 2015–2018 Risk Factor Survey Question Coding (Yes/No) Years of Available Data Subjective cognitive decline During the past 12 months, have you experienced confusion or memory loss that is happening more often or is getting worse? Used default All Limited educational attainment What is the highest grade or year of school you have completed? [ Never attended school or only kindergarten/Grades 1-8/Grades 9-11/Grade 12 or GED/College 1-3 years (includes technical school or associate’s degree)/College ≥4 years (bachelor’s degree or higher) ] Limited educational attainment (YES) was defined as never having attended school or only kindergarten or Grades 1-8 . All higher levels of education were classified as NO. All Deafness Are you deaf or do you have serious difficulty hearing? [ Yes/No ] Used default 2016–2018 Social isolation 1. How often do you get the social and emotional support you need? [ Always/Usually/Sometimes/Rarely/Never ] 2. Arthritis limited social activities by [ A Lot/A Little/Not Limited/Don’t Have Arthritis ] Social isolation (YES) was defined as never or rarely receiving needed social and emotional support and/or having social activities limited a lot by arthritis . Social isolation (NO) was defined as always, usually, or sometimes receiving needed social and emotional support . Respondents who did not answer question 1 or 2 or who did not answer question 1 and answered “A Little”, “Not Limited” or “Don’t Have Arthritis” were excluded. 1. 2015–2017 2. 2015, 2017 Depression Have you ever been told you have a depressive disorder including depression, major depression, dysthymia, or minor depression? [ Yes/No ] Used default All Smoking Have you smoked at least 100 cigarettes in your lifetime and are you currently smoking every day or some days? [ Yes/No ] Used default All Physical inactivity Have you engaged in physical activity or exercise during the past 30 days other than your regular job? [ Yes/No ] Used default All Obesity What is your body weight status as determined by Body Mass Index (BMI)? [ Underweight (≤ 18.49 kg/m 2 )/Healthy (18.50-24.99)/Overweight (25.00-29.99)/Obese (≥ 30.00) ] Obesity (YES) was defined as a body weight of obese , while Obesity (NO) was defined as a body weight of underweight, healthy, or overweight . All Hypertension Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure? [ Yes/No ] Hypertension (NO) was defined as never having had high blood pressure , or only having had borderline-high blood pressure or pre-hypertension , or only having had high blood pressure during pregnancy . All other cases of high blood pressure were classified as YES. All Diabetes Have you ever been told that you have diabetes? [ Yes/No ] Diabetes (NO) was defined as never having had diabetes , or only having had pre-diabetes or borderline diabetes , or only having had diabetes during pregnancy . All other cases of diabetes were classified as YES. All Table 1 (continued): Modifiable risk factors obtained from BRFSS, 2015–2018 Statistical analysis Variable States with Available Data Sample Size* Subjective cognitive decline Alabama, Alaska, Arizona, Arkansas, Delaware, District of Columbia, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, Puerto Rico 216,838 Limited educational attainment Alabama, Alaska, Arizona, Arkansas, Delaware, District of Columbia, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, Puerto Rico 216,231 Deafness Alaska, Delaware, Georgia, Hawaii, Idaho, Indiana, Kentucky, Massachusetts, Mississippi, Missouri, Montana, New Hampshire, New Jersey, New Mexico, North Carolina, Oregon, Pennsylvania, Tennessee, Vermont, Washington, Puerto Rico 100,825 Social isolation Alabama, Arizona, Arkansas, District of Columbia, Georgia, Hawaii, Illinois, Iowa, Louisiana, Minnesota, Mississippi, Nevada, New Jersey, North Dakota, Ohio, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Virginia, West Virginia, Wisconsin, Wyoming, Puerto Rico Total: 28,436 1. 18,168 2. 131,738 (11,102 for ‘arthritis limited social activities by a lot’) Depression Alabama, Alaska, Arizona, Arkansas, Delaware, District of Columbia, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, Puerto Rico 215,970 Smoking Alabama, Alaska, Arizona, Arkansas, Delaware, District of Columbia, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, Puerto Rico 215,536 Physical inactivity Alabama, Alaska, Arizona, Arkansas, Delaware, District of Columbia, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, Puerto Rico 216,395 Obesity Alabama, Alaska, Arizona, Arkansas, Delaware, District of Columbia, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, Puerto Rico 204,233 Hypertension Alabama, Arizona, Arkansas, District of Columbia, Georgia, Hawaii, Illinois, Iowa, Louisiana, Minnesota, Mississippi, Nevada, New Jersey, North Dakota, Ohio, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Virginia, West Virginia, Wisconsin, Wyoming, Puerto Rico 132,662 Diabetes Alabama, Alaska, Arizona, Arkansas, Delaware, District of Columbia, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, Puerto Rico 216,483 *Total n used in analysis of adults aged 45 and older from 2015-2018, excluding "Don't Know" and "Refused" responses. Table 2. Demographic characteristics of U.S. adults aged 45 years and older by sex, 2015–2018 Characteristic Frequency 2 (% 3 ) p -value 1 Men Women Total Sex 88,216 (46.30) 128,622 (53.70) 216,838 (100.00) — Age <.0001 45-49 8,787 (14.21) 11,066 (12.62) 19,853 (13.36) 50-54 11,050 (17.42) 14,662 (16.62) 25,712 (16.99) 55-59 12,894 (15.96) 17,573 (14.76) 30,467 (15.32) 60-64 14,285 (16.09) 19,570 (15.79) 33,855 (15.93) 65-69 14,501 (13.00) 20,043 (12.53) 34,544 (12.75) 70-74 10,605 (9.70) 16,215 (10.08) 26,820 (9.90) 75-79 7,152 (6.65) 11,997 (7.92) 19,149 (7.33) 80 or older 8,069 (6.97) 15,665 (9.68) 23,734 (8.42) Race/Ethnicity † 0.028 White 69,410 (75.14) 100,092 (75.49) 169,502 (75.33) Black 6,048 (10.86) 11,446 (11.23) 17,494 (11.06) Hispanic 5,127 (8.65) 7,974 (8.54) 13,101 (8.59) Asian/Native Hawaiian/Pacific Islander 2,154 (2.60) 2,604 (2.35) 4,758 (2.46) American Indian/Alaskan Native 1,282 (1.01) 1,680 (0.89) 2,962 (0.94) Multiracial 2,101 (1.34) 2,552 (1.17) 4,653 (1.25) Other 503 (0.41) 510 (0.32) 1,013 (0.36) Marital Status <.0001 Married 55,354 (65.61) 62,710 (55.53) 118,064 (60.21) Divorced/Separated 14,862 (16.83) 24,232 (18.01) 39,094 (17.46) Widowed 7,659 (6.87) 29,886 (18.14) 37,545 (12.92) Never married 8,291 (8.62) 9,116 (6.61) 17,407 (7.54) Member of an unmarried couple 1,625 (2.06) 1,848 (1.71) 3,473 (1.87) Income <.0001 Less than $15,000 6,791 (9.50) 13,779 (12.80) 20,570 (11.21) $15,000 to less than $25,000 10,935 (14.94) 19,679 (18.50) 30,614 (16.78) $25,000 to less than $35,000 7,829 (9.73) 12,211 (10.91) 20,040 (10.34) $35,000 to less than $50,000 11,265 (13.87) 14,972 (13.65) 26,237 (13.76) $50,000 or more 40,478 (51.96) 42,923 (44.14) 83,401 (47.91) Employment Status <.0001 Employed for wages 30,405 (39.56) 38,264 (34.47) 68,669 (36.82) Self-employed 10,197 (11.50) 7,285 (5.61) 17,482 (8.34) Out of work 3,161 (4.57) 3,891 (3.77) 7,052 (4.14) A homemaker 219 (0.31) 11,531 (10.77) 11,750 (5.93) A student 120 (0.11) 326 (0.31) 446 (0.22) Retired 36,437 (34.39) 54,246 (34.41) 90,683 (34.40) Unable to work 7,197 (9.57) 12,365 (10.65) 19,562 (10.15) Veteran Status <.0001 Veteran 31,046 (30.04) 2,701 (2.11) 33,747 (15.03) Not a veteran 57,006 (69.96) 125,850 (97.89) 182,856 (84.97) Subjective Cognitive Decline ^ 0.021 Yes 9,766 (11.15) 13,239 (10.60) 23,005 (10.86) No 78,450 (88.85) 115,383 (89.40) 193,833 (89.14) *Data aggregated from U.S. Behavioral Risk Factor Surveillance System, 2015-2018; estimates were weighted and adjusted for complex survey design. 1 Chi-square test measuring association between gender and demographic characteristics. 2 Unweighted frequency. 3 Weighted column or row percentage. †All race/ethnicity categories are non-Hispanic, unless otherwise noted. ^Experienced confusion or memory loss during the past 12 months that is happening more often or is getting worse (‘Yes’); otherwise (‘No’). Table 3 . Unadjusted modifiable risk factors for subjective cognitive decline in U.S. adults aged 45 years and older, 2015–2018 Risk factor RR 1 (95% CI 2 ) Prevalence (%) Communality 3 (%) PAF 4 (%) Weighted PAF 5 (%) All Adults Limited education a 1.60 (1.47-1.76) 4.78 66.19 2.81 0.85 Deafness b 2.60 (2.41-2.80) 9.66 39.81 13.38 4.05 Social isolation c 3.39 (3.10-3.71) 52.38 70.97 55.60 16.82 Depression d 4.17 (4.01-4.34) 18.76 56.15 37.30 11.29 Smoking e 1.71 (1.63-1.80) 15.46 64.26 9.90 3.00 Physical inactivity f 1.76 (1.68-1.83) 30.76 39.83 18.87 5.71 Obesity g 1.27 (1.22-1.33) 32.97 59.06 8.25 2.50 Hypertension h 1.62 (1.53-1.71) 50.99 57.99 23.95 7.25 Diabetes i 1.67 (1.59-1.75) 17.76 57.65 10.57 3.20 Overall 6 89.31 54.66 Women Limited education a 1.61 (1.42-1.83) 4.49 58.99 2.66 0.78 Deafness b 2.68 (2.37-3.02) 7.46 48.90 11.12 3.28 Social isolation c 3.23 (2.89-3.62) 55.70 69.20 55.41 16.31 Depression d 4.31 (4.07-4.55) 22.92 57.33 43.12 12.70 Smoking e 1.88 (1.76-2.01) 14.41 65.83 11.27 3.32 Physical inactivity f 1.79 (1.69-1.89) 32.25 41.35 20.23 5.96 Obesity g 1.40 (1.32-1.49) 32.08 64.84 11.35 3.34 Hypertension h 1.59 (1.48-1.70) 49.57 58.25 22.52 6.63 Diabetes i 1.74 (1.63-1.86) 16.73 59.35 10.98 3.23 Overall 6 90.51 55.55 Men Limited education a 1.60 (1.40-1.82) 5.11 26.67 2.96 1.01 Deafness b 2.54 (2.30-2.80) 12.22 20.30 15.82 5.38 Social isolation c 3.65 (3.16-4.21) 47.68 71.96 55.82 19.00 Depression d 4.33 (4.08-4.60) 13.94 39.75 31.72 10.80 Smoking e 1.54 (1.43-1.67) 16.68 50.75 8.29 2.82 Physical inactivity f 1.73 (1.62-1.85) 29.03 35.75 17.53 5.97 Obesity g 1.15 (1.08-1.23) 33.93 48.34 4.85 1.65 Hypertension h 1.65 (1.52-1.79) 52.63 57.98 25.55 8.70 Diabetes i 1.59 (1.48-1.70) 18.95 54.94 10.05 3.42 Overall 6 88.12 58.75 Data aggregated from U.S. Behavioral Risk Factor Surveillance System, 2015-2018; estimates were weighted and/or adjusted for complex survey design. Not all risk factors were available for every year of the survey. RR and PAF were unadjusted for demographic factors. 1 Relative risk and 2 confidence intervals for subjective cognitive decline. 3 Total amount of variance a risk factor shares with the other factors. 4 Population attributable fraction; proportion of all cases of subjective cognitive decline in the population that is attributable to a risk factor. 5 PAF after accounting for communality. 6 Combined PAF of all risk factors. 3-6 Please see Appendix for formulas. a Never attended school or discontinued after 8 th grade. b Includes serious difficulty hearing. c Never or rarely receive needed social and emotional support and/or have social activities significantly limited by arthritis. d Ever told to have a depressive disorder. e Currently smoke every day or some days and have smoked ≥ 100 cigarettes in lifetime. f No physical activity or exercise during past 30 days other than regular job. g Body mass index (BMI) ≥ 30.00 kg/m 2 . h Ever told to have high blood pressure by a health professional, excluding during pregnancy or borderline high, pre-hypertension. i Ever told to have diabetes, excluding gestational, borderline or pre-diabetes. Table 4 . Adjusted modifiable risk factors for subjective cognitive decline in U.S. adults aged 45 years and older, 2015–2018 Risk factor Adj RR 1 (95% CI 2 ) Prevalence (%) Communality 3 (%) Adj PAF 4 (%) Weighted Adj PAF 5 (%) All Adults Limited education a 1.12 (0.99-1.26) 4.78 66.19 0.59 0.20 Deafness b 2.01 (1.82-2.19) 9.66 39.81 8.87 2.96 Social isolation c 2.46 (2.15-2.77) 52.38 70.97 43.28 14.44 Depression d 3.12 (2.95-3.29) 18.76 56.15 28.47 9.50 Smoking e 1.20 (1.12-1.27) 15.46 64.26 2.97 0.99 Physical inactivity f 1.32 (1.25-1.39) 30.76 39.83 8.92 2.98 Obesity g 1.14 (1.08-1.19) 32.97 59.06 4.32 1.44 Hypertension h 1.28 (1.20-1.36) 50.99 57.99 12.57 4.20 Diabetes i 1.28 (1.21-1.35) 17.76 57.65 4.78 1.59 Overall 6 74.13 38.30 Women Limited education a 1.18 (0.97-1.38) 4.49 58.99 0.79 0.26 Deafness b 2.09 (1.79-2.38) 7.46 48.90 7.50 2.44 Social isolation c 2.48 (2.07-2.89) 55.70 69.20 45.21 14.72 Depression d 3.26 (3.01-3.50) 22.92 57.33 34.08 11.09 Smoking e 1.29 (1.18-1.40) 14.41 65.83 4.00 1.30 Physical inactivity f 1.32 (1.23-1.42) 32.25 41.35 9.45 3.07 Obesity g 1.14 (1.06-1.22) 32.08 64.84 4.37 1.42 Hypertension h 1.26 (1.15-1.37) 49.57 58.25 11.33 3.69 Diabetes i 1.32 (1.22-1.42) 16.73 59.35 5.10 1.66 Overall 6 76.81 39.65 Men Limited education a 1.05 (0.87-1.24) 5.11 26.67 0.28 0.11 Deafness b 1.93 (1.68-2.17) 12.22 20.30 10.16 3.86 Social isolation c 2.47 (1.98-2.96) 47.68 71.96 41.20 15.66 Depression d 3.23 (2.94-3.51) 13.94 39.75 23.68 9.00 Smoking e 1.11 (1.01-1.22) 16.68 50.75 1.86 0.71 Physical inactivity f 1.32 (1.22-1.42) 29.03 35.75 8.50 3.23 Obesity g 1.13 (1.04-1.21) 33.93 48.34 4.14 1.58 Hypertension h 1.32 (1.20-1.44) 52.63 57.98 14.44 5.49 Diabetes i 1.24 (1.14-1.34) 18.95 54.94 4.37 1.66 Overall 6 71.68 41.30 Data aggregated from U.S. Behavioral Risk Factor Surveillance System, 2015-2018; estimates were weighted and/or adjusted for complex survey design. Not all risk factors were available for every year of the survey. RR and PAF were adjusted (adj) for age, race, income, employment status, marital status, and veteran status. 1 Relative risk and 2 confidence intervals for subjective cognitive decline. 3 Total amount of variance a risk factor shares with the other factors. 4 Population attributable fraction; proportion of all cases of subjective cognitive decline in the population that is attributable to a risk factor. 5 PAF after accounting for communality. 6 Combined PAF of all risk factors. 3-6 Please see Appendix for formulas. a Never attended school or discontinued after 8 th grade. b Includes serious difficulty hearing. c Never or rarely receive needed social and emotional support and/or have social activities significantly limited by arthritis. d Ever told to have a depressive disorder. e Currently smoke every day or some days and have smoked ≥ 100 cigarettes in lifetime. f No physical activity or exercise during past 30 days other than regular job. g Body mass index (BMI) ≥ 30.00 kg/m 2 . h Ever told to have high blood pressure by a health professional, excluding during pregnancy or borderline high, pre-hypertension. i Ever told to have diabetes, excluding gestational, borderline or pre-diabetes. 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Also discoverable on Platform About In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1111688","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":68588615,"identity":"aec08920-5170-4a93-bf70-50beed4172c8","order_by":0,"name":"Karen Schliep","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYBACCRjDgJ2xgYGhAirEQ5QWZpCWM0ABErQACcY2IrRItp99+LiAoU7enJm58XHhvMN1/LMbGB+8bcOtRZon3dh4BsNhw53NjM3GM7cdlpC4c4DZcC4eLXIMaWzSPAwHEgwOM7ZJ8wK1MNxIYJPmxaeF/xn7bx6GOpCW9t+8cw5LyN9IYP+NT4u0RBobMw8DM9gWZt6GwxIGQFuY8WmRnPGMWZrH4LDhhsOMzdIzjqVLbryR2Cw55xxuLRLn0xg/81TUyRscb3/4uaDGml/uRvLBD2/KcGuBAAMIxQyhQHFKLGAmXukoGAWjYBSMJAAAS6tIRY7Tyx8AAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0003-1771-3157","institution":"University of Utah Health","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Karen","middleName":"","lastName":"Schliep","suffix":""},{"id":68588616,"identity":"8f7f0fa8-ccac-4bfc-a630-8282a586b85a","order_by":1,"name":"Lily Gu","email":"","orcid":"","institution":"University of Utah Health","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Lily","middleName":"","lastName":"Gu","suffix":""},{"id":68588617,"identity":"956517ac-d379-47c6-a0ae-1208fa719fcf","order_by":2,"name":"Kristine Lynch","email":"","orcid":"","institution":"University of Utah Health","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kristine","middleName":"","lastName":"Lynch","suffix":""},{"id":68588618,"identity":"08bfccd4-d29c-446b-915e-cecb3e6f5d2e","order_by":3,"name":"Michelle Sorweid","email":"","orcid":"","institution":"University of Utah Health","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Michelle","middleName":"","lastName":"Sorweid","suffix":""},{"id":68588619,"identity":"276fa135-7304-4171-a50c-7aaa8660cb74","order_by":4,"name":"Michael Varner","email":"","orcid":"","institution":"University of Utah Health","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Varner","suffix":""},{"id":68588620,"identity":"7022d99f-f2ba-4423-b7dc-ff99700b0552","order_by":5,"name":"Norman Foster","email":"","orcid":"","institution":"University of Utah Health","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Norman","middleName":"","lastName":"Foster","suffix":""},{"id":68588621,"identity":"b6833c66-f631-4ce5-a274-0dbc65cfdd64","order_by":6,"name":"Fares Qeadan","email":"","orcid":"","institution":"Loyola University Chicago","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Fares","middleName":"","lastName":"Qeadan","suffix":""}],"badges":[],"createdAt":"2021-11-24 17:16:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1111688/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1111688/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13293-022-00425-3","type":"published","date":"2022-04-12T06:54:07+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":16328807,"identity":"b50c7d1c-eb1e-409d-8a94-1871111d8c61","added_by":"auto","created_at":"2021-12-09 21:42:16","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1630133,"visible":true,"origin":"","legend":"Contributions of potentially modifiable risk factors to the overall weighted adjusted population attributable fraction for subjective cognitive decline in adults aged 45 and older (BRFSS: 2015–2018). Figure A=All adults (n=216,838); Figure B=Women (n=128,622); Figure C=Men (n=88,216).","description":"","filename":"Figure1ac.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1111688/v1/b946e869cd1850b04cea73b8.jpg"},{"id":20227030,"identity":"1b942205-0445-4a69-84aa-f214bd9924a5","added_by":"auto","created_at":"2022-04-12 06:54:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":614332,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1111688/v1/3ce840f1-f2a0-4e51-9c89-91ec35306782.pdf"},{"id":16328273,"identity":"1685d3aa-7554-4176-9a1b-ad69ff80cbc0","added_by":"auto","created_at":"2021-12-09 21:36:16","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":13985,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-1111688/v1/b92018b03f1fb33c3aa427df.docx"},{"id":16328566,"identity":"1fe85ca6-37b0-4fd7-a4e9-efc1906e9419","added_by":"auto","created_at":"2021-12-09 21:39:16","extension":"docx","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":120957,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile2.docx","url":"https://assets-eu.researchsquare.com/files/rs-1111688/v1/44ec808307eac16a87c96984.docx"},{"id":16328274,"identity":"6adad66b-2bdc-44ea-948f-c1300972acc0","added_by":"auto","created_at":"2021-12-09 21:36:16","extension":"docx","order_by":7,"title":"","display":"","copyAsset":false,"role":"supplement","size":17243,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile3.docx","url":"https://assets-eu.researchsquare.com/files/rs-1111688/v1/e9eb7b279c4f02f098a1427b.docx"},{"id":16328270,"identity":"1bc46a1f-930c-40a3-bf3d-77edef49a11e","added_by":"auto","created_at":"2021-12-09 21:36:16","extension":"docx","order_by":8,"title":"","display":"","copyAsset":false,"role":"supplement","size":17055,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile4.docx","url":"https://assets-eu.researchsquare.com/files/rs-1111688/v1/5cd12f5bab4281a27e7749f5.docx"}],"financialInterests":"","formattedTitle":"\u003cp\u003eOverall and Sex-Specific Risk Factors for Subjective Cognitive Decline: Findings From the 2015–2018 Behavioral Risk Factor Surveillance System Survey\u003c/p\u003e","fulltext":[{"header":"Highlights","content":"\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eSubjective Cognitive Decline (SCD) is one of the earliest noticeable symptoms of Alzheimer\u0026rsquo;s disease and related dementias.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWhile there is no current cure for dementia, research indicates that at least 35% of dementia risk may be modifiable by decreasing exposures years or even decades before cognitive decline becomes clinically evident.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePrior research has shown that the risk of dementia in individuals with cognitive impairment is higher in women than in men, as is the overall risk of dementia.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAmong a nationally representative population of over 200,000 adults, ages 45 years and older, SCD prevalence was 11% for both women and men.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWomen and men also had nearly equivalent overall population attributable fractions to explain subjective cognitive decline (39.7% for women versus 41.3% for men).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe top three contributing risk factors for both women and men were social isolation, depression, and hypertension, which explained three-quarters of the overall population attributable fraction.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eLife expectancy in developed countries is rising, with an estimated 50% of children born in 2000 expected to live to 100 years and beyond (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).This extended life expectancy is a public health success story; however, a consequence of this success includes higher rates of cognitive impairment and dementia, estimated to triple by 2050 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Subjective cognitive decline (SCD) is the self-reported experience of worsening or more frequent confusion or memory loss. It is considered to be one of the earliest noticeable symptoms of preclinical Alzheimer\u0026rsquo;s disease (AD) (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), although as illness progresses awareness of deficits decreases (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Several studies have shown that individuals with SCD have increased risk of subsequent objective cognitive decline including mild cognitive impairment and AD (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile there is no current cure for dementia, research indicates that at least 35% of dementia risk may modifiable by decreasing exposures years or even decades before cognitive decline becomes clinically evident (\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Key modifiable factors, identified through systematic reviews and meta-analyses, include low educational attainment, hearing loss, social isolation, depression, smoking, physical inactivity, obesity, hypertension, and diabetes (\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). These modifiable factors, and their relationship with cognitive impairment and dementia, vary based on sex, geography, and other factors. Since previous studies have shown that the risk of subsequent AD in individuals with cognitive impairment is higher in women than in men (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), as is the overall risk of dementia (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), an improved understanding of sex-specific differences in relation to how modifiable factors may impact cognitive dysfunction risk is needed.\u003c/p\u003e \u003cp\u003eIdentifying early risk factors for subsequent cognitive dysfunction is challenging. Research to date is largely derived from clinical rather than population-based cohorts and have focused on patients already presenting with dementia (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The Behavioral Risk Factor Surveillance System (BRFSS), a United States (US) nationally representative population-based survey administered by the Centers for Disease Control and Prevention, finalized its Cognitive Decline Module that captures SCD in 2015 (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The objective for this study was to use 2015\u0026ndash;2018 BRFSS data to determine the population attributable fraction (PAF) of nine known risk factors for SCD, with a focus on sex-specific disparities.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eAll men and women aged 45 years and older who completed the 2015\u0026ndash;2018 BRFSS survey, inclusive of the Cognitive Decline Module, were considered for this study. The purpose of the BRFSS, which began in 1984, is to assess health status and health behaviors of the US population based on self-reported responses (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The purpose of the Cognitive Decline Module, which was offered for the first time in 2011 and finalized and approved in 2015, is to monitor SCD and its associated effect or burden in the population (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The Cognitive Decline Module is an optional component offered to states who can elect or decline to include it in the BRFSS survey. Data are weighted by the Centers for Disease Control and Prevention to be representative of the population on a number of demographic characteristics, including sex, age, race, education, marital status, home ownership, phone ownership (landline telephone, cellular telephone or both) and sub-state region. From 2015\u0026ndash;2018, all 50 states plus the District of Columbia and Puerto Rico have administered the Cognitive Decline Module at least once.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eMeasure for cognitive decline\u003c/h2\u003e \u003cp\u003eSCD was determined based on a binary \u0026lsquo;Yes\u0026rsquo; or \u0026lsquo;No\u0026rsquo; response to the first question of the Cognitive Decline Module: \u0026lsquo;During the past 12 months, have you experienced confusion or memory loss that is happening more often or is getting worse?\u0026rsquo; Individuals who responded \u0026lsquo;Yes\u0026rsquo; or \u0026lsquo;No\u0026rsquo; to this question were included in the analysis (\u003cem\u003en\u003c/em\u003e=216,838), while those who answered \u0026lsquo;Don\u0026rsquo;t Know/Not Sure\u0026rsquo; (\u003cem\u003en\u003c/em\u003e=1,501) or \u0026lsquo;Refused\u0026rsquo; (\u003cem\u003en\u003c/em\u003e=437) were excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eRisk factors for cognitive decline\u003c/h2\u003e \u003cp\u003eFor comparability with prior research (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), we examined nine key modifiable risk factors for dementia, which were selected from a list of risk factors provided by the United Kingdom National Institute of Health and Care Excellence and the US National Institutes of Health (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Nine binary risk factors were derived from standard BRFSS self-reported questions and defined as \u0026lsquo;Yes\u0026rsquo; or \u0026lsquo;No\u0026rsquo; variables (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Prior research has documented the reliability and validity of the BRFSS questionnaire (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). We excluded Refused, Don\u0026rsquo;t Know, Unsure, Missing, and Unknown responses. Some risk factors were not available in every year of BRFSS from 2015\u0026ndash;2018 (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eDue to the complex survey design of BRFSS, statistical analyses incorporated clustering (\u003cem\u003ePSU\u003c/em\u003e), stratification (\u003cem\u003eSTSTR\u003c/em\u003e), and weighting (\u003cem\u003eLLCPWT\u003c/em\u003e), following established Centers for Disease Control and Prevention methodology, which uses iterative proportional fitting weighting since 2011 (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). All results provided in this study were weighted estimates adjusted for disproportionate non-response, non-coverage, and other sampling bias. Descriptive statistics of respondent demographics were calculated for the total population, as well as by sex. For each risk factor, relative risk (RR) and 95% confidence intervals (CI) for SCD were estimated, both unadjusted and adjusted for demographic factors including age, race, income, employment, marital status, and Veteran status. Given that age of a respondent at the time they completed the survey may act as an effect modifier between sex or modifiable risk factors and SCD, we ran our analyses stratified by age (\u0026lt;65 years versus \u0026ge;65 years). Principal component analysis based on a weighted tetrachoric correlation matrix of the nine risk factors was performed to calculate communality of each risk factor, which refers to the total amount of shared variance among risk factors. Due to current limitations in statistical software, stratification and clustering were not incorporated in the calculations for communality. The PAF for each risk factor and all risk factors combined (overall PAF) were calculated using formulas (\u003cb\u003eSee Additional file 1\u003c/b\u003e) provided by Livingston \u003cem\u003eet al\u003c/em\u003e. and Mukadam \u003cem\u003eet al\u003c/em\u003e. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), with weighting to account for communality, as well as adjustment for demographic factors (WaPAF). All statistical analyses were conducted using SAS 9.4 (Cary, North Carolina, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003ePopulation characteristics\u003c/h2\u003e \u003cp\u003eThe study consisted of more women (53.7%) than men, with more women than men aged 70 years or older (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Three-quarters of the study population were non-Hispanic white, 11.1% were non-Hispanic black, 8.6% were Hispanic, and 5.0% were either non-Hispanic Asian/Native Hawaiian/Pacific Islander, non-Hispanic American Indian/Alaskan Native, or non-Hispanic individuals of other or multiple races. Compared to women, men were more likely to be younger at the time of interview, married, employed, have a higher income, and have Veteran status. Women were more than twice as likely to be widowed as men. Overall, 10.9% of adults reported experiencing symptoms of SCD, with slightly more men (11.2%) compared to women (10.6%) reporting SCD. The relationship between respondent\u0026rsquo;s age and report of SCD differed between men and women. For men, a near linear relationship between age and probability of SCD was found. For women, the relationship was more \u0026ldquo;S\u0026rdquo; shaped with women ages 50\u0026ndash;54 showing a higher probability of SCD compared to women ages 60\u0026ndash;64 or 70\u0026ndash;74 (\u003cb\u003eSee Additional file 2\u003c/b\u003e)\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eRelative risk for subjective cognitive decline\u003c/h2\u003e \u003cp\u003eAmong all adults, exposure to any of the nine identified risk factors was positively associated with the risk of SCD in the unadjusted models (Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) and after adjusting for age, race, income, employment status, marital status, and Veteran status (Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The leading risk factors included depression, social isolation, and deafness, where adults with depressive disorders were three times more likely to have SCD than adults without (adjusted risk ratio (aRR): 3.12, 95% CI: 2.95, 3.29), and adults who did versus did not experience social isolation or deafness carried more than double the risk of SCD (aRR: 2.46, 95% CI: 2.15, 2.77; aRR: 2.01, 95% CI: 1.82, 2.19, respectively). Adults who were physically inactive (aRR: 1.32, 95% CI: 1.25, 1.39), had hypertension (aRR: 1.28, 95% CI: 1.20, 1.36) or diabetes (aRR: 1.28, 95% CI: 1.21, 1.35), or currently smoked (aRR: 1.20, 95% CI: 1.12, 1.27) carried a 20\u0026ndash;32% increased risk for SCD compared to their non-exposed counterparts. Adults who were obese (aRR: 1.14, 95% CI: 1.08, 1.19) or had limited education (aRR: 1.12; 95% CI: 0.99, 1.26) carried a 12\u0026ndash;14% increased risk compared to their non-exposed counterparts.\u003c/p\u003e\u003cp\u003eYounger adults (\u0026lt; 65 years), compared to older adults (\u0026ge; 65 years), had significantly greater risk for SCD from depression (aRR: 3.34, 95% CI: 3.10, 3.59; vs. aRR: 2.72, 95% CI: 2.48, 2.95), smoking (aRR: 1.24, 95% CI: 1.15, 1.33; vs. aRR: 0.98, 95% CI: 0.86, 1.11), and hypertension (aRR: 1.38, 95% CI: 1.26, 1.49; vs. aRR: 1.10, 95% CI: 1.01, 1.20) (\u003cb\u003eSee Additional files 3 and 4\u003c/b\u003e). These differences between age groups were mostly derived from sex-specific discrepancies. For instance, women aged \u0026lt; 65 had greater risk for SCD from smoking (aRR: 1.37, 95% CI 1.24, 1.50) compared to women aged \u0026ge; 65 (aRR: 1.01, 95% CI 0.83, 1.19). Men aged \u0026le; 64, compared to men aged \u0026ge; 65, had greater risk for SCD from depression (aRR: 3.63, 95% CI 3.20, 4.06; vs. aRR: 2.55, 95% CI 2.23, 2.86) and hypertension (aRR: 1.51, 95% CI 1.31, 1.71; vs. aRR: 1.06, 95% CI 0.93, 1.19). However, among adults aged \u0026ge; 65, women had greater risk for SCD from depression (aRR: 3.52, 95% CI: 3.12, 3.92) compared to men (aRR: 2.55, 95% CI: 2.23, 2.86).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePopulation attributable fraction of risk factors\u003c/h2\u003e \u003cp\u003eCollectively, the nine risk factors in this study were estimated to be attributed to 74.1% of all cases of SCD in the population, after adjusting for age, race, income, employment status, marital status, and Veteran status (Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). After accounting for the shared variance among risk factors, the hypothetical elimination of all exposures predicted a reduction in SCD by over one-third (WaPAF 38.3%). Women and men had nearly equivalent overall WaPAFs to explain SCD (39.7% for women compared to 41.3% for men). Similar findings existed among men and women of different age groups, with a WaPAF of 41.9% observed among adults \u0026lt;65 and a WaPAF of 36.7% among adults \u0026ge;65 (See Additional files 3 and 4).\u003c/p\u003e \u003cp\u003eNearly 38% of SCD cases in the population could be attributable to social isolation (WaPAF 14.4%), while 25% could be attributable to depression (WaPAF 9.5%) and 11% to hypertension (WaPAF 4.2%). Physical inactivity (WaPAF 3.0%), deafness (WaPAF 3.0%), diabetes (WaPAF 1.6%), obesity (WaPAF 1.4%), smoking (WaPAF 1.0%) and limited education (WaPAF 0.2%) accounted for the remaining 27% PAF for SCD (Figure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ea). Depression, smoking, diabetes, and limited education contributed more to SCD in women than men, while social isolation, hypertension, physical inactivity, obesity, and deafness, contributed more to SCD in men than women (Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). However, there was little difference in regards to the magnitude of contributing factors between sexes (\u003cb\u003eFigure 1bc\u003c/b\u003e). Among adults aged 65 and older, limited educational attainment no longer contributed to SCD risk among women (WaPAF 0.00%), while smoking no longer contributed to SCD risk among men (WaPAF 0.00%) (See Additional file 4).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eMain findings\u003c/h2\u003e \u003cp\u003eIn this large representative sample of US adults aged 45 and older, we found that more than 1 in 10 survey respondents reported SCD and nearly 40% of SCD could be attributed to known modifiable factors. Overall, the top three contributing risk factors were social isolation, depression and hypertension, which contributed three-quarters of the adjusted PAF for SCD. Physical inactivity, deafness, diabetes, obesity, smoking, and limited education contributed the remaining quarter. Little difference between women and men was found for the attributable proportion of SCD that may be amenable to prevention. However, further research is warranted for exploring other modifiable factors that have recently been shown to be associated with cognitive decline, including heavy alcohol consumption, traumatic brain injury, and air pollution (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), in addition to reproductive health history (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), which may contribute to SCD risk and sex-specific SCD risk.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSignificance of results\u003c/h2\u003e \u003cp\u003eOur study is novel in using data from a US nationally representative population-based survey to determine modifiable risk factors for subjective cognitive decline. Prior studies have used pooled estimates from meta-analyses (\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) or smaller prospective cohorts in other countries (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) to calculate PAFs for dementia. While epidemiologic evidence has shown that SCD significantly increases risk for later mild cognitive impairment and dementia, the majority of individuals with SCD (which can be caused by several medical conditions) will not go on to develop cognitive decline (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Current research, for which our findings may help inform, is focused on understanding what characteristics cause some individuals with SCD to go on to develop dementia compared to others who remain cognitively normal (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Despite different cognitive outcome assessments and study designs, we found it reassuring that our results for SCD were comparable to prior research for dementia outcomes, which demonstrate between 35% and 50% of dementia risk may be amenable to prevention (\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Given that we had limited data for deafness, hypertension and most notably for social isolation, we advise caution in interpreting our findings as to what factors contribute the most to SCD. While our findings are in line with past research on importance of hypertension and hearing loss in relation to cognitive health, there is limited research on social isolation. Further research with gold-standard methods to capture social isolation and with complete data is needed before definitive conclusions can be made.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eComparison with other studies\u003c/h2\u003e \u003cp\u003eThe \u003cem\u003eLancet\u003c/em\u003e Commission on Dementia Prevention, Intervention, and Care reported in 2017 that 35% of dementia cases could theoretically be preventable by eliminating the following risk factors: limited education in early life (8%), mid-life hearing loss (9%), hypertension (2%), obesity (1%), later life smoking (5%), depression (4%), physical inactivity (3%), social isolation (2%) and diabetes (1%) (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In a recently published 2020 report update, the Commission added three additional modifiable factors\u0026mdash;excessive alcohol consumption (\u0026gt;21 units/week), traumatic brain injury, and air pollution\u0026mdash;which has raised the theoretical proportion of worldwide dementia that could be prevented to 40% (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile we determined a similar attributable fraction as the 2017 Commission (38% vs. 35%, respectively), using the same modifiable factors and methodology (WaPAF), the relative contributions of the modifiable factors differed. The Commission reported that hearing loss, limited education, and smoking contributed to over half the attributable fraction for dementia, while in the BRFSS, we found that social isolation, depression, and hypertension were responsible for nearly three-quarters of the attributable fraction for SCD.\u003c/p\u003e \u003cp\u003eThese differences may be attributed to many factors including differences in population characteristics (e.g., clinical versus population-based samples) and the fact that the Commission assessed modifiable factors for dementia while we were assessing modifiable factors for SCD, a potential early indicator of subsequent dementia. Additionally, while we used similar methodology for calculating the PAFs for modifiable factors as the \u003cem\u003eLancet\u003c/em\u003e Commission including consideration of confounding factors for RRs and accounting for communality of risk factors (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), our calculation of RR estimates for modifiable factors differed greatly from that of the Commission. They extensively reviewed the international literature conducted predominately over the past two decades on each contributing risk factor and either applied previously published pooled RRs or calculated pooled RRs based on their own meta-analysis. Furthermore, to calculate communality, they used a representative sample of over 10,000 UK community-dwelling adults (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). For our analysis on SCD, we used a single data source within the US to calculate both our adjusted RRs and communality of risk factors within a recent specified time frame (2015\u0026ndash;2018).\u003c/p\u003e \u003cp\u003eUsing similar methodology to the Commission in identifying aRRs for potentially modifiable risk factors for Alzheimer's disease via systematic reviews and meta-analyses, another prior study found an overall adjusted PAF of 54.1% for Alzheimer's disease (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Given that communality was not considered, this estimate would be equivalent to the Commission\u0026rsquo;s unweighted PAF of 88.8% or our finding in the BRFSS of 74.1%. Additionally, this prior study assessed seven factors (low education, smoking, physical inactivity, depression, mid-life hypertension, diabetes and mid-life obesity) (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), so comparing impact of the additional two factors in the Commission (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) and our study\u0026mdash;hearing loss and social isolation\u0026mdash;is not possible. It is notable that while limited education contributed to the highest population attributable risk in the global assessment (19.1%), and backed up by other European prospective cohort studies (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), it dropped to second to last (PAR 7.3%) in the US assessment. This demonstrates the importance of calculating country-specific attributable proportions for dementia and cognitive impairment.\u003c/p\u003e \u003cp\u003eRegarding sex differences in modifiable factors for SCD, we, along with a prior study using data from the 2011 BRFSS SCD module (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) found no appreciable differences between men and women in prevalence or risk factors for SCD. Findings on sex differences in AD and related dementia risk is also limited; and at present equivocal (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). For example, research from a subset of the Framingham Heart Study (1975\u0026ndash;2009) found lifetime risk of Alzheimer\u0026rsquo;s disease and related dementia at age 45 to be 1 in 5 in women compared to 1 in 10 in men (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), while research from the Rochester Epidemiology Project (1985\u0026ndash;1989) found no difference in risk between men and women (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Differences in these two studies highlight the need to consider study population characteristics when assessing sex-specific Alzheimer\u0026rsquo;s disease and related dementia risk. Furthermore, even if incidence or prevalence of SCD or dementia is equal in men and women in any given population, as we found in the BRFSS data, risk factors for SCD and dementia may still differ (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Sex differences for AD and dementia have been found for depression, sleep apnea, low education, marital status, and reproductive events unique to each sex (such as pregnancy and menopause for women and androgen-deprivation therapy for men) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Clearly, despite our finding of no appreciable differences in contributing factors for SCD between men and women, more research is warranted assessing other risk factors that could not be assessed in this analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eOur study addressed prior gaps in the literature, including being one of the first studies to use recent data from a large population-based survey to assess PAFs of modifiable factors for SCD, while considering correlation between risk factors. This differs from other studies, which have focused on Alzheimer\u0026rsquo;s disease or all-cause dementia, versus SCD, or that have relied on meta-analyses for adjusted RR estimates (\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), or which rely on unique cohorts from other countries which may not be generalizable to the US population (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Despite our unique contribution, our study had several limitations. First, information for SCD and risk factors was based on self-reported data, which is susceptible to measurement error, especially since people experiencing cognitive decline are more likely to have anosognosia or be unaware of their deficits (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). While anosognosia is associated with disease severity (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) and consequently individuals with SCD are less likely to be susceptible to anosognosia than individuals with Alzheimer\u0026rsquo;s disease or other dementia, we realize that anxiety around cognitive performance may still result in differential misclassification of the outcome or differential selection related to participants with SCD skipping over the cognitive questions. Additionally, individuals with severe SCD are most likely excluded since BRFSS respondents who complete the survey are deemed by themselves or another household member to be mentally fit to respond to the survey (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). While the BRFSS finalized 2015 Cognitive Decline module includes only one question to determine SCD (with an additional 5 questions to assess whether SCD affects respondent\u0026rsquo;s functioning), further research using multi-item measures of SCD (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) would help differentiate how modifiable factors may impact various SCD subtypes (e.g., amnestic versus non-amnestic SCD or single-domain versus multiple-domain SCD) (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile self-report of cognitive decline and risk factors for cognitive decline have their limitations, they also have their strengths. For example, we used BRFSS questions that were better aligned with perceived social isolation rather than risk factors for social isolation, such as number of people living in household. This is important since perceived social isolation is usually more qualitative than quantitative in nature (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Another limitation of this study is the cross-sectional nature of the BRFSS survey, limiting ability to distinguish cause and effect. Only limited education, as defined, would precede SCD. To best assess risk, prospective cohort studies following young adults longitudinally, capturing modifiable factors over time and subsequent SCD are warranted. Longitudinal studies would also allow better capture of time-varying confounders or modifiers that may impact risk factors and SCD, such as personality factors or depression (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Finally, we had incomplete data on hypertension, deafness, and most notably social isolation; and failed to include newly reported modifiable risk factors, including heavy alcohol consumption, traumatic brain injury, or air pollution, as reported in the 2020 by the \u003cem\u003eLancet\u003c/em\u003e Commission (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Other potentially modifiable factors known to differ between men and women in relation to AD or related dementia risk, inclusive of cardiometabolic and reproductive health factors, also warrant further research.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, in this large nationally representative US sample of community-dwelling adults, we found that roughly 1 in 10 reported SCD with nearly 40% attributable to modifiable factors, including social isolation, depression, and hypertension, which explained nearly three-quarters of the attributable fraction. Further research, ideally in longitudinal cohorts assessing time-varying risk factors and SCD from early to late adulthood, is needed before definitive conclusions can be made. However, given recent findings from the SPRINT MIND trial showing that intensive blood pressure control can significantly reduce the risk of mild cognitive impairment (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), our findings documenting the high attributable fraction of hypertension in relation to SCD in a community-based sample suggest that blood pressure control may mitigate risk of SCD in over 50% of the US population over age 45. Additionally, prior research suggesting the positive link between social relationships and cognitive functioning (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) or long-term selective serotonin reuptake inhibitor treatment for depression and delayed progression to dementia (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e) suggest early intervention strategies may have a significant impact on reducing or at least delaying cognitive impairment within the US population. While our study indicated minimal difference in prevalence or risk factors for SCD between sexes, further research assessing reproductive and endocrinological health history in addition to biological factors that interact with sex-related factors that can be modified (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) should be conducted within population-based samples.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAD: Alzheimer\u0026rsquo;s disease; aRR: adjusted relative risk; BRFSS: Behavioral Risk Factor Surveillance System; CI: confidence interval; RR: relative risk; PAF: population attributable fraction; SCD, subjective cognitive decline; WaPAF: weighted adjusted population attributable fraction.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThe Institutional Review Board (IRB) of the researchers\u0026rsquo; institution recognize that the analysis of de-identified, publicly available data does not constitute human subjects research as defined in federal regulations, and as such does not require IRB review. Human subjects review was not sought nor received.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eBFFSS is a publically available dataset overseen by the Centers for Disease Control and Prevention. Survey data and documentation is available at\u0026nbsp;\u003ca href=\"https://www.cdc.gov/brfss/data_documentation/index.htm\"\u003ehttps://www.cdc.gov/brfss/data_documentation/index.htm\u003c/a\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors have no conflicts of interest relevant to this study to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding: \u0026nbsp;\u003c/strong\u003eResearch reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Number K01AG058781. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contribution:\u0026nbsp;\u003c/strong\u003eAll authors assisted in the development of the research question and study design. LYG completed the data analyses, and KCS wrote the original manuscript draft. All authors contributed to the manuscript preparation and revision. All authors reviewed, edited, and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e: Initial findings from this project were presented as an oral presentation at the Sex, Gender, and Women\u0026rsquo;s Health Across the Lifespan, Virtual Symposium. University of Utah Center of Excellence in Women\u0026rsquo;s Health and the Eccles Health Sciences Library; May 14, 2020; Salt Lake City, Utah as well as via a poster presentation at the Society of Epidemiologic Research; June 2021; Virtual Conference.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eCrimmins EM. Lifespan and Healthspan: Past, Present, and Promise. 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BMC medical research methodology. 2013;13:1\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eCenters for Disease Control and Prevention. The BRFSS data user guide. 2013.\u0026nbsp;\u003c/span\u003e\u003cspan\u003ehttps://. Accessed November 20, 2021.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMukadam N, Sommerlad A, Huntley J, Livingston G. Population attributable fractions for risk factors for dementia in low-income and middle-income countries: an analysis using cross-sectional survey data. Lancet Glob Health. 2019;7:e596-e603.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eNajar J, Ostling S, Waern M, Zettergren A, Kern S, Wetterberg H, et al. Reproductive period and dementia: A 44-year longitudinal population study of Swedish women. Alzheimers Dement. 2020;16:1153\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eRitchie K, Carriere I, Ritchie CW, Berr C, Artero S, Ancelin ML. Designing prevention programmes to reduce incidence of dementia: prospective cohort study of modifiable risk factors. BMJ. 2010:c3885.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eRolandi E, Zaccaria D, Vaccaro R, Abbondanza S, Pettinato L, Davin A, et al. Estimating the potential for dementia prevention through modifiable risk factors elimination in the real-world setting: a population-based study. Alzheimers Res Ther. 2020;12:94.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eJessen F, Amariglio RE, Buckley RF, van der Flier WM, Han Y, Molinuevo JL, et al. The characterisation of subjective cognitive decline. Lancet Neurol. 2020;19:271\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eAdams ML, Grandpre J. Dose-response gradients between a composite measure of six risk factors and cognitive decline and cardiovascular disease. Prev Med. 2016;91:329\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMielke MM. Sex and gender differences in Alzheimer\u0026rsquo;s disease dementia. The Psychiatric times. 2018;35:14.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eEdmonds EC, Weigand AJ, Thomas KR, Eppig J, Delano-Wood L, Galasko DR, et al. Increasing inaccuracy of self-reported subjective cognitive complaints over 24 months in empirically-derived subtypes of mild cognitive impairment. Journal of the International Neuropsychological Society: JINS. 2018;24:842.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMondrag\u0026oacute;n JD, Maurits NM, De Deyn PP. Functional neural correlates of anosognosia in mild cognitive impairment and alzheimer\u0026rsquo;s disease: a systematic review. Neuropsychol Rev. 2019:1\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003ePrevention CfDCa. Centers for Disease Control and Prevention, Healthy Aging Program Georgia, Atlanta, 2015. Cognitive decline module \u0026ndash; behavioral risk factor surveillance system (BRFSS) 2015 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.cdc.gov/aging/healthybrain\u003c/span\u003e\u003c/span\u003e. Accessed November 20, 2021.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eGifford KA, Liu D, Romano R, 3rd, Jones RN, Jefferson AL. Development of a subjective cognitive decline questionnaire using item response theory: a pilot study. Alzheimers Dement (Amst). 2015;1:429\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eDiaz-Galvan P, Ferreira D, Cedres N, Falahati F, Hernandez-Cabrera JA, Ames D, et al. Comparing different approaches for operationalizing subjective cognitive decline: impact on syndromic and biomarker profiles. Sci Rep. 2021;11:4356.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eHawkley LC, Capitanio JP. Perceived social isolation, evolutionary fitness and health outcomes: a lifespan approach. Philos Trans R Soc Lond B Biol Sci. 2015;370.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMunoz N, Goma IFM, Valero S, Rodriguez-Gomez O, Sanabria A, Perez-Cordon A, et al. Personality Factors and Subjective Cognitive Decline: The FACEHBI Cohort. Behav Neurol. 2020;2020:5232184.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKim D, Wang R, Kiss A, Bronskill SE, Lanctot KL, Herrmann N, et al. Depression and Increased Risk of Alzheimer\u0026apos;s Dementia: Longitudinal Analyses of Modifiable Risk and Sex-Related Factors. Am J Geriatr Psychiatry. 2021 Sep;29:917\u0026ndash;926.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eGroup SMIftSR, Williamson JD, Pajewski NM, Auchus AP, Bryan RN, Chelune G, et al. Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia: A Randomized Clinical Trial. JAMA. 2019;321:553\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKelly ME, Duff H, Kelly S, McHugh Power JE, Brennan S, Lawlor BA, et al. The impact of social activities, social networks, social support and social relationships on the cognitive functioning of healthy older adults: a systematic review. Syst Rev. 2017;6:259.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eBartels C, Wagner M, Wolfsgruber S, Ehrenreich H, Schneider A, Alzheimer\u0026apos;s Disease Neuroimaging I. Impact of SSRI Therapy on Risk of Conversion From Mild Cognitive Impairment to Alzheimer\u0026apos;s Dementia in Individuals With Previous Depression. Am J Psychiatry. 2018;175:232\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1:\u0026nbsp;\u003c/strong\u003eModifiable risk factors obtained from BRFSS, 2015\u0026ndash;2018\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003e\u003cstrong\u003eRisk Factor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.375%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurvey Question\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.375%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCoding (Yes/No)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.25%\"\u003e\n \u003cp\u003e\u003cstrong\u003eYears of Available Data\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003eSubjective cognitive decline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.375%\"\u003e\n \u003cp\u003eDuring the past 12 months, have you experienced confusion or memory loss that is happening more often or is getting worse?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"39.375%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eUsed default\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.25%\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003eLimited educational attainment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.375%\"\u003e\n \u003cp\u003eWhat is the highest grade or year of school you have completed?\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[\u003cem\u003eNever attended school or only kindergarten/Grades 1-8/Grades 9-11/Grade 12 or GED/College 1-3 years (includes technical school or associate\u0026rsquo;s degree)/College \u0026ge;4 years (bachelor\u0026rsquo;s degree or higher)\u003c/em\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"39.375%\"\u003e\n \u003cp\u003eLimited educational attainment (YES) was defined as \u003cem\u003enever having attended school or only kindergarten or\u003c/em\u003e \u003cem\u003eGrades 1-8\u003c/em\u003e. All higher levels of education were classified as NO.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.25%\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003eDeafness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.375%\"\u003e\n \u003cp\u003eAre you deaf or do you have serious difficulty hearing? [\u003cem\u003eYes/No\u003c/em\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.375%\"\u003e\n \u003cp\u003eUsed default\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.25%\"\u003e\n \u003cp\u003e2016\u0026ndash;2018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003eSocial isolation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.375%\"\u003e\n \u003cp\u003e1. How often do you get the social and emotional support you need? [\u003cem\u003eAlways/Usually/Sometimes/Rarely/Never\u003c/em\u003e]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2. Arthritis limited social activities by [\u003cem\u003eA Lot/A Little/Not Limited/Don\u0026rsquo;t Have Arthritis\u003c/em\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.375%\"\u003e\n \u003cp\u003eSocial isolation (YES) was defined as \u003cem\u003enever or rarely receiving needed social and emotional support\u003c/em\u003e \u003cem\u003eand/or\u003c/em\u003e \u003cem\u003ehaving social activities limited a lot by arthritis\u003c/em\u003e. Social isolation (NO) was defined as \u003cem\u003ealways, usually, or sometimes receiving needed social and emotional support\u003c/em\u003e. Respondents who did not answer question 1 or 2 or who did not answer question 1 and answered \u0026ldquo;A Little\u0026rdquo;, \u0026ldquo;Not Limited\u0026rdquo; or \u0026ldquo;Don\u0026rsquo;t Have Arthritis\u0026rdquo; were excluded.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.25%\"\u003e\n \u003cp\u003e1. 2015\u0026ndash;2017\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2. 2015, 2017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.375%\"\u003e\n \u003cp\u003eHave you ever been told you have a depressive disorder including depression, major depression, dysthymia, or minor depression? [\u003cem\u003eYes/No\u003c/em\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"39.375%\"\u003e\n \u003cp\u003eUsed default\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.25%\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.375%\"\u003e\n \u003cp\u003eHave you smoked at least 100 cigarettes in your lifetime and are you currently smoking every day or some days? [\u003cem\u003eYes/No\u003c/em\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.375%\"\u003e\n \u003cp\u003eUsed default\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.25%\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003ePhysical inactivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.375%\"\u003e\n \u003cp\u003eHave you engaged in physical activity or exercise during the past 30 days other than your regular job? [\u003cem\u003eYes/No\u003c/em\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.375%\"\u003e\n \u003cp\u003eUsed default\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.25%\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003eObesity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.375%\"\u003e\n \u003cp\u003eWhat is your body weight status as determined by Body Mass Index (BMI)? [\u003cem\u003eUnderweight (\u0026le; 18.49 kg/m\u003csup\u003e2\u003c/sup\u003e)/Healthy (18.50-24.99)/Overweight (25.00-29.99)/Obese (\u0026ge; 30.00)\u003c/em\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.375%\"\u003e\n \u003cp\u003eObesity (YES) was defined as a body weight of \u003cem\u003eobese\u003c/em\u003e, while Obesity (NO) was defined as a body weight of \u003cem\u003eunderweight, healthy, or overweight\u003c/em\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.25%\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.375%\"\u003e\n \u003cp\u003eHave you ever been told by a doctor, nurse, or other health professional that you have high blood pressure? [\u003cem\u003eYes/No\u003c/em\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.375%\"\u003e\n \u003cp\u003eHypertension (NO) was defined as \u003cem\u003enever having had high blood pressure\u003c/em\u003e, \u003cem\u003eor only having had borderline-high blood pressure or pre-hypertension\u003c/em\u003e, \u003cem\u003eor\u003c/em\u003e \u003cem\u003eonly having had high blood pressure during pregnancy\u003c/em\u003e. All other cases of high blood pressure were classified as YES.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.25%\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.375%\"\u003e\n \u003cp\u003eHave you ever been told that you have diabetes? [\u003cem\u003eYes/No\u003c/em\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.375%\"\u003e\n \u003cp\u003eDiabetes (NO) was defined as \u003cem\u003enever having had diabetes\u003c/em\u003e, \u003cem\u003eor\u003c/em\u003e \u003cem\u003eonly having had pre-diabetes or borderline diabetes\u003c/em\u003e, \u003cem\u003eor\u003c/em\u003e \u003cem\u003eonly having had diabetes during pregnancy\u003c/em\u003e. All other cases of diabetes were classified as YES.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.25%\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 (continued):\u0026nbsp;\u003c/strong\u003eModifiable risk factors obtained from BRFSS, 2015\u0026ndash;2018\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical analysis\u003c/em\u003e\u003c/p\u003e\n\u003ctable align=\"left\" border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.592255125284739%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"67.65375854214123%\"\u003e\n \u003cp\u003e\u003cstrong\u003eStates with Available Data\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"21.753986332574033%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSample Size*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.592255125284739%\"\u003e\n \u003cp\u003eSubjective cognitive decline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.65375854214123%\"\u003e\n \u003cp\u003eAlabama, Alaska, Arizona, Arkansas, Delaware, District of Columbia, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, Puerto Rico\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.753986332574033%\"\u003e\n \u003cp\u003e216,838\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.592255125284739%\"\u003e\n \u003cp\u003eLimited educational attainment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.65375854214123%\"\u003e\n \u003cp\u003eAlabama, Alaska, Arizona, Arkansas, Delaware, District of Columbia, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, Puerto Rico\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.753986332574033%\"\u003e\n \u003cp\u003e216,231\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.592255125284739%\"\u003e\n \u003cp\u003eDeafness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.65375854214123%\"\u003e\n \u003cp\u003eAlaska, Delaware, Georgia, Hawaii, Idaho, Indiana, Kentucky, Massachusetts, Mississippi, Missouri, Montana, New Hampshire, New Jersey, New Mexico, North Carolina, Oregon, Pennsylvania, Tennessee, Vermont, Washington, Puerto Rico\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.753986332574033%\"\u003e\n \u003cp\u003e100,825\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"10.592255125284739%\"\u003e\n \u003cp\u003eSocial isolation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" width=\"67.65375854214123%\"\u003e\n \u003cp\u003eAlabama, Arizona, Arkansas, District of Columbia, Georgia, Hawaii, Illinois, Iowa, Louisiana, Minnesota, Mississippi, Nevada, New Jersey, North Dakota, Ohio, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Virginia, West Virginia, Wisconsin, Wyoming, Puerto Rico\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.753986332574033%\"\u003e\n \u003cp\u003eTotal: 28,436\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"100%\"\u003e\n \u003cp\u003e1. 18,168\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\"\u003e\n \u003cp\u003e2. 131,738 (11,102 for\u0026nbsp;\u0026lsquo;arthritis limited social activities by a lot\u0026rsquo;)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.592255125284739%\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.65375854214123%\"\u003e\n \u003cp\u003eAlabama, Alaska, Arizona, Arkansas, Delaware, District of Columbia, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, Puerto Rico\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.753986332574033%\"\u003e\n \u003cp\u003e215,970\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.592255125284739%\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.65375854214123%\"\u003e\n \u003cp\u003eAlabama, Alaska, Arizona, Arkansas, Delaware, District of Columbia, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, Puerto Rico\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.753986332574033%\"\u003e\n \u003cp\u003e215,536\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.592255125284739%\"\u003e\n \u003cp\u003ePhysical inactivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.65375854214123%\"\u003e\n \u003cp\u003eAlabama, Alaska, Arizona, Arkansas, Delaware, District of Columbia, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, Puerto Rico\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.753986332574033%\"\u003e\n \u003cp\u003e216,395\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.592255125284739%\"\u003e\n \u003cp\u003eObesity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.65375854214123%\"\u003e\n \u003cp\u003eAlabama, Alaska, Arizona, Arkansas, Delaware, District of Columbia, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, Puerto Rico\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.753986332574033%\"\u003e\n \u003cp\u003e204,233\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.592255125284739%\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.65375854214123%\"\u003e\n \u003cp\u003eAlabama, Arizona, Arkansas, District of Columbia, Georgia, Hawaii, Illinois, Iowa, Louisiana, Minnesota, Mississippi, Nevada, New Jersey, North Dakota, Ohio, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Virginia, West Virginia, Wisconsin, Wyoming, Puerto Rico\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.753986332574033%\"\u003e\n \u003cp\u003e132,662\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.592255125284739%\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.65375854214123%\"\u003e\n \u003cp\u003eAlabama, Alaska, Arizona, Arkansas, Delaware, District of Columbia, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, Puerto Rico\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.753986332574033%\"\u003e\n \u003cp\u003e216,483\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" width=\"100%\"\u003e\n \u003cp\u003e*Total \u003cem\u003en\u003c/em\u003e used in analysis of adults aged 45 and older from 2015-2018, excluding \u0026quot;Don\u0026apos;t Know\u0026quot; and \u0026quot;Refused\u0026quot; responses.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eDemographic characteristics of U.S. adults aged 45 years and older by sex, 2015\u0026ndash;2018\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"37.22943722943723%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" width=\"48.484848484848484%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003csup\u003e2\u003c/sup\u003e (%\u003csup\u003e3\u003c/sup\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.571428571428573%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.285714285714285%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWomen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.142857142857146%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.852813852813853%\"\u003e\n \u003cp\u003e88,216 (46.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.047619047619047%\"\u003e\n \u003cp\u003e128,622 (53.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e216,838 (100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026mdash;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.584415584415584%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003e45-49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e8,787 (14.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e11,066 (12.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.584415584415584%\"\u003e\n \u003cp\u003e19,853 (13.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003e50-54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e11,050 (17.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e14,662 (16.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.584415584415584%\"\u003e\n \u003cp\u003e25,712 (16.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003e55-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e12,894 (15.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e17,573 (14.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.584415584415584%\"\u003e\n \u003cp\u003e30,467 (15.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003e60-64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e14,285 (16.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e19,570 (15.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.584415584415584%\"\u003e\n \u003cp\u003e33,855 (15.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003e65-69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e14,501 (13.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e20,043 (12.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.584415584415584%\"\u003e\n \u003cp\u003e34,544 (12.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003e70-74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e10,605 (9.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e16,215 (10.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.584415584415584%\"\u003e\n \u003cp\u003e26,820 (9.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003e75-79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e7,152 (6.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e11,997 (7.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.584415584415584%\"\u003e\n \u003cp\u003e19,149 (7.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003e80 or older\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e8,069 (6.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e15,665 (9.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.584415584415584%\"\u003e\n \u003cp\u003e23,734 (8.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003e\u003cstrong\u003eRace/Ethnicity\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.584415584415584%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"37.22943722943723%\"\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e69,410 (75.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e100,092 (75.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e169,502 (75.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"37.22943722943723%\"\u003e\n \u003cp\u003eBlack\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e6,048 (10.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e11,446 (11.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e17,494 (11.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"37.22943722943723%\"\u003e\n \u003cp\u003eHispanic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e5,127 (8.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e7,974 (8.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e13,101 (8.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"37.22943722943723%\"\u003e\n \u003cp\u003eAsian/Native Hawaiian/Pacific Islander\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e2,154 (2.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e2,604 (2.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e4,758 (2.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"37.22943722943723%\"\u003e\n \u003cp\u003eAmerican Indian/Alaskan Native\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e1,282 (1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e1,680 (0.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e2,962 (0.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"37.22943722943723%\"\u003e\n \u003cp\u003eMultiracial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e2,101 (1.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e2,552 (1.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e4,653 (1.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"37.22943722943723%\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e503 (0.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e510 (0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e1,013 (0.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.584415584415584%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e55,354 (65.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e62,710 (55.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e118,064 (60.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003eDivorced/Separated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e14,862 (16.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e24,232 (18.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e39,094 (17.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e7,659 (6.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e29,886 (18.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e37,545 (12.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003eNever married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e8,291 (8.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e9,116 (6.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e17,407 (7.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003eMember of an unmarried couple\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e1,625 (2.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e1,848 (1.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e3,473 (1.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.584415584415584%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003eLess than $15,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e6,791 (9.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e13,779 (12.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e20,570 (11.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003e$15,000 to less than $25,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e10,935 (14.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e19,679 (18.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e30,614 (16.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003e$25,000 to less than $35,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e7,829 (9.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e12,211 (10.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e20,040 (10.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003e$35,000 to less than $50,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e11,265 (13.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e14,972 (13.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e26,237 (13.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003e$50,000 or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e40,478 (51.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e42,923 (44.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e83,401 (47.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.584415584415584%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003eEmployed for wages\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e30,405 (39.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e38,264 (34.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e68,669 (36.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003eSelf-employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e10,197 (11.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e7,285 (5.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e17,482 (8.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003eOut of work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e3,161 (4.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e3,891 (3.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e7,052 (4.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003eA homemaker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e219 (0.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e11,531 (10.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e11,750 (5.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003eA student\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e120 (0.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e326 (0.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e446 (0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e36,437 (34.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e54,246 (34.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e90,683 (34.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003eUnable to work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e7,197 (9.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e12,365 (10.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e19,562 (10.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVeteran Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.584415584415584%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003eVeteran\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e31,046 (30.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e2,701 (2.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.584415584415584%\"\u003e\n \u003cp\u003e33,747 (15.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003eNot a veteran\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\n \u003cp\u003e57,006 (69.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\n \u003cp\u003e125,850 (97.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e182,856 (84.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubjective Cognitive Decline\u003csup\u003e^\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.852813852813853%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.584415584415584%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.852813852813853%\"\u003e\n \u003cp\u003e9,766 (11.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.047619047619047%\"\u003e\n \u003cp\u003e13,239 (10.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e23,005 (10.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.22943722943723%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.852813852813853%\"\u003e\n \u003cp\u003e78,450 (88.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.047619047619047%\"\u003e\n \u003cp\u003e115,383 (89.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e193,833 (89.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" width=\"100%\"\u003e\n \u003cp\u003e*Data aggregated from U.S. Behavioral Risk Factor Surveillance System, 2015-2018; estimates were weighted and adjusted for complex survey design.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" width=\"100%\"\u003e\n \u003cp\u003e\u003csup\u003e1\u003c/sup\u003eChi-square test measuring association between gender and demographic characteristics. \u003csup\u003e2\u003c/sup\u003eUnweighted frequency. \u003csup\u003e3\u003c/sup\u003eWeighted column or row percentage.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" width=\"100%\"\u003e\n \u003cp\u003e\u0026dagger;All race/ethnicity categories are non-Hispanic, unless otherwise noted.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" width=\"100%\"\u003e\n \u003cp\u003e^Experienced confusion or memory loss during the past 12 months that is happening more often or is getting worse (\u0026lsquo;Yes\u0026rsquo;); otherwise (\u0026lsquo;No\u0026rsquo;).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e. Unadjusted modifiable risk factors for subjective cognitive decline in U.S. adults aged 45 years and older, 2015\u0026ndash;2018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.363636363636363%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.09090909090909%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.909090909090908%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u003cstrong\u003eRisk factor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e\u003cstrong\u003eRR\u003csup\u003e1\u003c/sup\u003e (95% CI\u003csup\u003e2\u003c/sup\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.363636363636363%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevalence (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.09090909090909%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCommunality\u003csup\u003e3\u003c/sup\u003e (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.909090909090908%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePAF\u003csup\u003e4\u003c/sup\u003e (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeighted PAF\u003csup\u003e5\u003c/sup\u003e (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.363636363636363%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.09090909090909%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.909090909090908%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll Adults\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003eLimited education\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e1.60 (1.47-1.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e4.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e66.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e2.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003eDeafness\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e2.60 (2.41-2.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e9.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e39.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e13.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e4.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003eSocial isolation\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e3.39 (3.10-3.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e52.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e70.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e55.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e16.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003eDepression\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e4.17 (4.01-4.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e18.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e56.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e37.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e11.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003eSmoking\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e1.71 (1.63-1.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e15.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e64.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e9.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e3.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003ePhysical inactivity\u003csup\u003ef\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e1.76 (1.68-1.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e30.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e39.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e18.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e5.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003eObesity\u003csup\u003eg\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e1.27 (1.22-1.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e32.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e59.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e8.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e2.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003eHypertension\u003csup\u003eh\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e1.62 (1.53-1.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e50.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e57.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e23.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e7.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003eDiabetes\u003csup\u003ei\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e1.67 (1.59-1.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e17.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e57.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e10.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e3.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.09090909090909%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003csup\u003e6\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e89.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e54.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.363636363636363%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.09090909090909%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.909090909090908%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWomen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003eLimited education\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e1.61 (1.42-1.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e4.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e58.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e2.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003eDeafness\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e2.68 (2.37-3.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e7.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e48.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e11.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e3.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003eSocial isolation\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e3.23 (2.89-3.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e55.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e69.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e55.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e16.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003eDepression\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e4.31 (4.07-4.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e22.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e57.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e43.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e12.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003eSmoking\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e1.88 (1.76-2.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e14.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e65.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e11.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e3.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003ePhysical inactivity\u003csup\u003ef\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e1.79 (1.69-1.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e32.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e41.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e20.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e5.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003eObesity\u003csup\u003eg\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e1.40 (1.32-1.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e32.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e64.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e11.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e3.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003eHypertension\u003csup\u003eh\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e1.59 (1.48-1.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e49.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e58.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e22.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e6.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003eDiabetes\u003csup\u003ei\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e1.74 (1.63-1.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e16.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e59.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e10.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e3.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.09090909090909%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003csup\u003e6\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e90.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e55.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.363636363636363%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.09090909090909%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.909090909090908%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003eLimited education\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e1.60 (1.40-1.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e5.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e26.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e2.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003eDeafness\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e2.54 (2.30-2.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e12.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e20.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e15.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e5.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003eSocial isolation\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e3.65 (3.16-4.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e47.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e71.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e55.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e19.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003eDepression\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e4.33 (4.08-4.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e13.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e39.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e31.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e10.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003eSmoking\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e1.54 (1.43-1.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e16.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e50.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e8.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e2.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003ePhysical inactivity\u003csup\u003ef\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e1.73 (1.62-1.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e29.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e35.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e17.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e5.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003eObesity\u003csup\u003eg\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e1.15 (1.08-1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e33.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e48.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e4.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e1.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003eHypertension\u003csup\u003eh\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e1.65 (1.52-1.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e52.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e57.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e25.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e8.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003eDiabetes\u003csup\u003ei\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.454545454545455%\"\u003e\n \u003cp\u003e1.59 (1.48-1.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e18.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.09090909090909%\"\u003e\n \u003cp\u003e54.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e10.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e3.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.181818181818183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"15.454545454545455%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"16.363636363636363%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.09090909090909%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003csup\u003e6\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.909090909090908%\"\u003e\n \u003cp\u003e88.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e58.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003eData aggregated from U.S. Behavioral Risk Factor Surveillance System, 2015-2018; estimates were weighted and/or adjusted for complex survey design. Not all risk factors were available for every year of the survey. RR and PAF were unadjusted for demographic factors.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003csup\u003e1\u003c/sup\u003eRelative risk and \u003csup\u003e2\u003c/sup\u003econfidence intervals for subjective cognitive decline. \u003csup\u003e3\u003c/sup\u003eTotal amount of variance a risk factor shares with the other factors.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003csup\u003e4\u003c/sup\u003ePopulation attributable fraction; proportion of all cases of subjective cognitive decline in the population that is attributable to a risk factor.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003csup\u003e5\u003c/sup\u003ePAF after accounting for communality. \u003csup\u003e6\u003c/sup\u003eCombined PAF of all risk factors. \u003csup\u003e3-6\u003c/sup\u003ePlease see \u003cem\u003eAppendix\u003c/em\u003e for formulas.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003csup\u003ea\u003c/sup\u003eNever attended school or discontinued after 8\u003csup\u003eth\u003c/sup\u003e grade.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003csup\u003eb\u003c/sup\u003eIncludes serious difficulty hearing.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003csup\u003ec\u003c/sup\u003eNever or rarely receive needed social and emotional support and/or have social activities significantly limited by arthritis.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003csup\u003ed\u003c/sup\u003eEver told to have a depressive disorder.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003csup\u003ee\u003c/sup\u003eCurrently smoke every day or some days and have smoked \u0026ge; 100 cigarettes in lifetime.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003csup\u003ef\u003c/sup\u003eNo physical activity or exercise during past 30 days other than regular job. \u003csup\u003eg\u003c/sup\u003eBody mass index (BMI) \u0026ge; 30.00 kg/m\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003csup\u003eh\u003c/sup\u003eEver told to have high blood pressure by a health professional, excluding during pregnancy or borderline high, pre-hypertension.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003csup\u003ei\u003c/sup\u003eEver told to have diabetes, excluding gestational, borderline or pre-diabetes.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e. Adjusted modifiable risk factors for subjective cognitive decline in U.S. adults aged 45 years and older, 2015\u0026ndash;2018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003e\u003cstrong\u003eRisk factor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdj RR\u003csup\u003e1\u003c/sup\u003e (95% CI\u003csup\u003e2\u003c/sup\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.754098360655737%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevalence (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.21311475409836%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCommunality\u003csup\u003e3\u003c/sup\u003e (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.114754098360656%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdj PAF\u003csup\u003e4\u003c/sup\u003e (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.311475409836067%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeighted Adj PAF\u003csup\u003e5\u003c/sup\u003e (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"14.754098360655737%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"17.21311475409836%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"13.114754098360656%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.311475409836067%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll Adults\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003eLimited education\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e1.12 (0.99-1.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e4.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e66.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003eDeafness\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e2.01 (1.82-2.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e9.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e39.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e8.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e2.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003eSocial isolation\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e2.46 (2.15-2.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e52.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e70.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e43.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e14.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003eDepression\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e3.12 (2.95-3.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e18.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e56.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e28.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e9.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003eSmoking\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e1.20 (1.12-1.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e15.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e64.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e2.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003ePhysical inactivity\u003csup\u003ef\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e1.32 (1.25-1.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e30.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e39.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e8.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e2.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003eObesity\u003csup\u003eg\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e1.14 (1.08-1.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e32.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e59.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e4.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e1.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003eHypertension\u003csup\u003eh\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e1.28 (1.20-1.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e50.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e57.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e12.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e4.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003eDiabetes\u003csup\u003ei\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e1.28 (1.21-1.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e17.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e57.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e4.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e1.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.21311475409836%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003csup\u003e6\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e74.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e38.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"14.754098360655737%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"17.21311475409836%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"13.114754098360656%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.311475409836067%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWomen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003eLimited education\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e1.18 (0.97-1.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e4.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e58.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003eDeafness\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e2.09 (1.79-2.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e7.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e48.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e7.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e2.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003eSocial isolation\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e2.48 (2.07-2.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e55.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e69.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e45.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e14.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003eDepression\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e3.26 (3.01-3.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e22.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e57.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e34.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e11.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003eSmoking\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e1.29 (1.18-1.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e14.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e65.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e4.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e1.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003ePhysical inactivity\u003csup\u003ef\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e1.32 (1.23-1.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e32.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e41.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e9.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e3.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003eObesity\u003csup\u003eg\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e1.14 (1.06-1.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e32.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e64.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e4.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003eHypertension\u003csup\u003eh\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e1.26 (1.15-1.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e49.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e58.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e11.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e3.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003eDiabetes\u003csup\u003ei\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e1.32 (1.22-1.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e16.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e59.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e5.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e1.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.21311475409836%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003csup\u003e6\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e76.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e39.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"14.754098360655737%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"17.21311475409836%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"13.114754098360656%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.311475409836067%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003eLimited education\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e1.05 (0.87-1.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e5.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e26.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003eDeafness\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e1.93 (1.68-2.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e12.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e20.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e10.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e3.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003eSocial isolation\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e2.47 (1.98-2.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e47.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e71.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e41.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e15.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003eDepression\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e3.23 (2.94-3.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e13.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e39.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e23.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e9.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003eSmoking\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e1.11 (1.01-1.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e16.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e50.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e1.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003ePhysical inactivity\u003csup\u003ef\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e1.32 (1.22-1.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e29.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e35.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e8.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e3.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003eObesity\u003csup\u003eg\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e1.13 (1.04-1.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e33.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e48.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e4.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e1.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003eHypertension\u003csup\u003eh\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e1.32 (1.20-1.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e52.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e57.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e14.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e5.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003eDiabetes\u003csup\u003ei\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.07650273224044%\"\u003e\n \u003cp\u003e1.24 (1.14-1.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e18.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.21311475409836%\"\u003e\n \u003cp\u003e54.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e4.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e1.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.530054644808743%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"17.07650273224044%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"14.754098360655737%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.21311475409836%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003csup\u003e6\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.114754098360656%\"\u003e\n \u003cp\u003e71.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.311475409836067%\"\u003e\n \u003cp\u003e41.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003eData aggregated from U.S. Behavioral Risk Factor Surveillance System, 2015-2018; estimates were weighted and/or adjusted for complex survey design. Not all risk factors were available for every year of the survey. RR and PAF were adjusted (adj) for age, race, income, employment status, marital status, and veteran status.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003csup\u003e1\u003c/sup\u003eRelative risk and \u003csup\u003e2\u003c/sup\u003econfidence intervals for subjective cognitive decline. \u003csup\u003e3\u003c/sup\u003eTotal amount of variance a risk factor shares with the other factors.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003csup\u003e4\u003c/sup\u003ePopulation attributable fraction; proportion of all cases of subjective cognitive decline in the population that is attributable to a risk factor.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003csup\u003e5\u003c/sup\u003ePAF after accounting for communality. \u003csup\u003e6\u003c/sup\u003eCombined PAF of all risk factors. \u003csup\u003e3-6\u003c/sup\u003ePlease see \u003cem\u003eAppendix\u003c/em\u003e for formulas.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003csup\u003ea\u003c/sup\u003eNever attended school or discontinued after 8\u003csup\u003eth\u003c/sup\u003e grade.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003csup\u003eb\u003c/sup\u003eIncludes serious difficulty hearing.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003csup\u003ec\u003c/sup\u003eNever or rarely receive needed social and emotional support and/or have social activities significantly limited by arthritis.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003csup\u003ed\u003c/sup\u003eEver told to have a depressive disorder.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003csup\u003ee\u003c/sup\u003eCurrently smoke every day or some days and have smoked \u0026ge; 100 cigarettes in lifetime.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003csup\u003ef\u003c/sup\u003eNo physical activity or exercise during past 30 days other than regular job. \u003csup\u003eg\u003c/sup\u003eBody mass index (BMI) \u0026ge; 30.00 kg/m\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" width=\"100%\"\u003e\n \u003cp\u003e\u003csup\u003eh\u003c/sup\u003eEver told to have high blood pressure by a health professional, excluding during pregnancy or borderline high, pre-hypertension.\u003c/p\u003e\n \u003cp\u003e\u003csup\u003ei\u003c/sup\u003eEver told to have diabetes, excluding gestational, borderline or pre-diabetes.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"biology-of-sex-differences","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bosd","sideBox":"Learn more about [Biology of Sex Differences](http://bsd.biomedcentral.com)","snPcode":"13293","submissionUrl":"https://submission.nature.com/new-submission/13293/3","title":"Biology of Sex Differences","twitterHandle":"@BiologySexDiff","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Subjective Cognitive Decline, Dementia, Cognitive Dysfunction, Behavioral Risk Factor Surveillance System, Risk Factors, Sex Factors","lastPublishedDoi":"10.21203/rs.3.rs-1111688/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1111688/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePrior research indicates that at least 35% of Alzheimer\u0026rsquo;s disease and related dementia risk may be amenable to prevention. Subjective cognitive decline is often the first indication of preclinical dementia, with the risk of subsequent Alzheimer\u0026rsquo;s disease in such individuals being greater in women than men. We wished to understand how modifiable factors are associated with subjective cognitive decline, and whether differences exist by sex.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eData were collected from men and women (45 years and older) who completed the U.S. Behavioral Risk Factor Surveillance System Cognitive Decline Module (2015\u0026ndash;2018), \u003cem\u003en\u003c/em\u003e=216,838. We calculated population attributable fractions for subjective cognitive decline, stratified by sex, of the following factors: limited education, deafness, social isolation, depression, smoking, physical inactivity, obesity, hypertension, and diabetes. Our models were adjusted for age, race, income, employment, marital and Veteran status, and accounted for communality among risk factors.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe final study sample included more women (53.7%) than men, but both had a similar prevalence of subjective cognitive decline (10.6% of women versus 11.2% of men). Women and men had nearly equivalent overall population attributable fractions to explain subjective cognitive decline (39.7% for women versus 41.3% for men). The top three contributing risk factors were social isolation, depression, and hypertension, which explained three-quarters of the overall population attributable fraction.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eWhile we did not identify any differences in modifiable factors between men and women contributing to subjective cognitive decline, other factors including reproductive or endocrinological health history or biological factors that interact with sex to modify risk warrant further research.\u003c/p\u003e","manuscriptTitle":"Overall and Sex-Specific Risk Factors for Subjective Cognitive Decline: Findings From the 2015–2018 Behavioral Risk Factor Surveillance System Survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-12-09 21:36:14","doi":"10.21203/rs.3.rs-1111688/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2021-12-07T17:46:06+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2021-12-07T16:16:02+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2021-11-30T19:15:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"Biology of Sex Differences","date":"2021-11-29T16:06:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"biology-of-sex-differences","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bosd","sideBox":"Learn more about [Biology of Sex Differences](http://bsd.biomedcentral.com)","snPcode":"13293","submissionUrl":"https://submission.nature.com/new-submission/13293/3","title":"Biology of Sex Differences","twitterHandle":"@BiologySexDiff","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"118885cb-075c-4964-9c50-82cf8fbda806","owner":[],"postedDate":"December 9th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":9040245,"name":"Preventive Medicine"},{"id":9040246,"name":"Internal Medicine"},{"id":9040247,"name":"Epidemiology"}],"tags":[],"updatedAt":"2022-04-12T06:54:07+00:00","versionOfRecord":{"articleIdentity":"rs-1111688","link":"https://doi.org/10.1186/s13293-022-00425-3","journal":{"identity":"biology-of-sex-differences","isVorOnly":false,"title":"Biology of Sex Differences"},"publishedOn":"2022-04-12 06:54:07","publishedOnDateReadable":"April 12th, 2022"},"versionCreatedAt":"2021-12-09 21:36:14","video":"","vorDoi":"10.1186/s13293-022-00425-3","vorDoiUrl":"https://doi.org/10.1186/s13293-022-00425-3","workflowStages":[]},"version":"v1","identity":"rs-1111688","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1111688","identity":"rs-1111688","version":["v1"]},"buildId":"pf3fE39SIOqb-0xH_OWvX","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}