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A data-driven prospective study of incident dementia among older adults in the United States

We conducted a prospective analysis of incident dementia and its association with 65 sociodemographic, early-life, economic, health and behavioral, social, and genetic risk factors in a sample of 7,908 adults over the age of 50 from the nationally representative US-based Health and Retirement Study. We used traditional survival analysis methods (Fine-Gray models) and a data-driven approach (random survival forests for competing risks) which allowed us to account for the competing risk of death with up to 14 years of follow-up. Overall, the top five predictors across all groups were lower education, loneliness, lower wealth and income, and lower self-reported health. However, we observed variation in the leading predictors of dementia across racial/ethnic and gender groups. Our ranked lists may be useful for guiding future observational and quasi-experimental research that investigates understudied domains of risk and emphasizes life course economic and health conditions as well as disparities therein.