Sex/Gender, Relationship Status, and Alzheimer’s and Related Dementia Diagnoses after Probable Dementia
Bibliographic record
Abstract
Abstract Background Differences by relationship status have been found in both cognitive‐assessment scores and prevalence and incidence rates for Alzheimer’s disease and related dementias (ADRD), but little is known about delayed and missed ADRD diagnoses after cognitive impairment emerges. Existing research has reported underdiagnosis for people of color, men, and people with less education. Method Using data from the Health and Retirement Study (2000‐2018), we analyzed associations between relationship status and time to ADRD diagnosis following probable dementia (PD). We examined risk of ADRD diagnosis by sex/gender and relationship status (married/partnered or single at the time of the first PD‐scoring assessment), adjusting for race/ethnicity, age, and education. Cox proportional hazards modeling was used to account for right‐censoring, with the risk period beginning at the time of the incident PD. Failure occurred when ADRD diagnosis was self‐reported. We also examined time until diagnosis among all participants with a recorded case of incident PD (N = 3,216 subjects: 9,540 observations). Restricted mean times to diagnosis and multivariable‐adjusted hazard ratios (aHR) with 95% Confidence Intervals (95% C.I.) were reported. Result Table 1 shows summary statistics; Table 2 provides hazard ratios; Table 3 shows mean times to diagnosis. Married/partnered women had the highest likelihood of receiving a diagnosis during the study period (HR: 1.197; 95% CI: 1.020‐1.360; p = <.001); single woman also had higher risk of diagnosis (HR: 1.178; 95% CI: 1.025–1.400; p = <.001). Mean time to diagnosis for men was 8.69 (±0.20); for women, 7.38 (±0.13). Singles received diagnoses sooner (7.32±0.135 years) than married/partnered people (8.39±0.169). Categorizing by sex/gender and relationship status, married/partnered women have the lowest mean times (7.00±0.148); single and married/partnered men’s mean times to diagnosis do not differ. Conclusion Relationship status is associated with women’s likelihood of reporting ADRD diagnosis and time to diagnosis, but not men’s. Further investigation is required to analyze potential sources of this disparity, including interactions with education, income, and insurance status, and additional gendered relationship, social, and familial factors.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".