Table 2.
Associations of lifestyle factors and sleep duration with Alzheimer’s disease among 28,775 Swedish adults ≥65 years of age, 1998–2014
| All participants | Women | Men | ||||||
| Modifiable factor | Casesa | Person-yearsa | Age- and sex-adjusted HR (95% CI) | Multivariable HR (95% CI)b | Casesa | Multivariable HR (95% CI)b | Casesa | Multivariable HR (95% CI)b |
| DASH diet score | ||||||||
| Quartile 1 | 921 | 84,732 | 1.00 (reference) | 1.00 (reference) | 503 | 1.00 (reference) | 418 | 1.00 (reference) |
| Quartile 2 | 916 | 89,802 | 0.96 (0.88–1.05) | 0.96 (0.88–1.06) | 509 | 1.02 (0.90–1.15) | 407 | 0.90 (0.79–1.04) |
| Quartile 3 | 913 | 91,126 | 0.94 (0.86–1.03) | 0.94 (0.85–1.03) | 498 | 0.97 (0.85–1.10) | 415 | 0.90 (0.78–1.03) |
| Quartile 4 | 1005 | 97,696 | 0.98 (0.90–1.08) | 0.96 (0.87–1.05) | 512 | 0.95 (0.84–1.08) | 493 | 0.97 (0.84–1.11) |
| Mediterranean diet score | ||||||||
| Quartile 1 | 1055 | 95,348 | 1.00 (reference) | 1.00 (reference) | 587 | 1.00 (reference) | 468 | 1.00 (reference) |
| Quartile 2 | 877 | 88,237 | 0.93 (0.85–1.01) | 1.03 (0.88–1.21) | 465 | 1.09 (0.89–1.33) | 412 | 0.92 (0.70–1.21) |
| Quartile 3 | 836 | 82,319 | 0.94 (0.86–1.03) | 1.11 (0.95–1.31) | 450 | 1.11 (0.91–1.35) | 386 | 1.10 (0.84–1.43) |
| Quartile 4 | 987 | 97,452 | 0.96 (0.88–1.05) | 1.12 (0.96–1.31) | 520 | 1.13 (0.93–1.38) | 467 | 1.08 (0.84–1.41) |
| Coffee consumption | ||||||||
| <1.0 cups/day | 176 | 17,351 | 1.00 (reference) | 1.00 (reference) | 95 | 1.00 (reference) | 81 | 1.00 (reference) |
| 1.0–2.9 cups/day | 1483 | 143,919 | 0.98 (0.84–1.14) | 0.99 (0.85–1.16) | 807 | 0.94 (0.76–1.17) | 676 | 1.07 (0.85–1.35) |
| 3.0–4.9 cups/day | 1383 | 133,880 | 1.01 (0.86–1.18) | 1.03 (0.88–1.21) | 774 | 1.03 (0.83–1.28) | 609 | 1.03 (0.82–1.31) |
| ≥5.0 cups/day | 486 | 49,254 | 1.07 (0.90–1.27) | 1.07 (0.90–1.28) | 225 | 1.11 (0.87–1.41) | 261 | 1.07 (0.83–1.37) |
| Alcohol consumption | ||||||||
| Lifelong abstainer | 589 | 48,928 | 1.00 (reference) | 1.00 (reference) | 462 | 1.00 (reference) | 127 | 1.00 (reference) |
| Former drinker | 218 | 20,591 | 1.05 (0.89–1.22) | 0.97 (0.83–1.15) | 47 | 0.80 (0.59–1.09) | 171 | 1.12 (0.89–1.42) |
| Current <1 drink/week | 835 | 72,747 | 1.04 (0.94–1.16) | 1.03 (0.92–1.14) | 605 | 0.98 (0.87–1.11) | 230 | 1.18 (0.94–1.47) |
| Current 1–6 drinks/week | 1424 | 145,586 | 0.98 (0.89–1.09) | 0.96 (0.86–1.06) | 703 | 0.97 (0.85–1.09) | 721 | 1.01 (0.83–1.23) |
| Current 7–14 drinks/week | 389 | 44,608 | 0.96 (0.84–1.10) | 0.93 (0.81–1.07) | 87 | 0.85 (0.67–1.08) | 302 | 1.03 (0.83–1.28) |
| Current 14–21 drinks/week | 81 | 9482 | 0.98 (0.77–1.24) | 0.94 (0.74–1.19) | 10 | 0.94 (0.50–1.76) | 71 | 1.01 (0.75–1.36) |
| Current >21 drinks/week | 71 | 8489 | 1.00 (0.78–1.29) | 0.94 (0.73–1.21) | 6 | 0.63 (0.28–1.42) | 65 | 1.06 (0.78–1.44) |
| Smoking | ||||||||
| Never | 2100 | 196,510 | 1.00 (reference) | 1.00 (reference) | 1432 | 1.00 (reference) | 668 | 1.00 (reference) |
| Former (any pack-years) | 1037 | 103,271 | 1.13 (1.04–1.22) | 1.13 (1.04–1.23) | 329 | 1.19 (1.05–1.35) | 708 | 1.10 (0.98–1.23) |
| <20 pack-yearsc | 598 | 59,075 | 1.12 (1.02–1.23) | 1.12 (1.02–1.24) | 232 | 1.14 (0.98–1.31) | 366 | 1.11 (0.97–1.27) |
| ≥20 pack-yearsc | 275 | 31,122 | 1.10 (0.96–1.25) | 1.10 (0.96–1.26) | 62 | 1.37 (1.05–1.77) | 213 | 1.04 (0.88–1.22) |
| Current (any pack-years) | 618 | 63,576 | 1.11 (1.01–1.21) | 1.10 (1.00–1.21) | 261 | 1.05 (0.91–1.20) | 357 | 1.14 (1.00–1.30) |
| <20 pack-yearsc | 281 | 29,691 | 1.02 (0.90–1.15) | 1.01 (0.89–1.15) | 156 | 1.00 (0.85–1.19) | 125 | 1.02 (0.84–1.24) |
| ≥20 pack-yearsc | 248 | 26,931 | 1.18 (1.03–1.34) | 1.17 (1.02–1.34) | 86 | 1.08 (0.86–1.34) | 162 | 1.23 (1.03–1.47) |
| Walking/bicycling | ||||||||
| Almost never | 424 | 38,891 | 1.00 (reference) | 1.00 (reference) | 252 | 1.00 (reference) | 172 | 1.00 (reference) |
| <20 min/day | 559 | 62,860 | 0.88 (0.77–1.00) | 0.89 (0.78–1.01) | 279 | 0.88 (0.74–1.05) | 280 | 0.91 (0.75–1.10) |
| 20–40 min/day | 1017 | 103,747 | 0.91 (0.81–1.02) | 0.91 (0.81–1.03) | 564 | 0.86 (0.74–1.01) | 453 | 0.99 (0.82–1.19) |
| 40–60 min/day | 679 | 64,923 | 0.99 (0.88–1.12) | 0.99 (0.87–1.13) | 374 | 0.98 (0.83–1.16) | 305 | 1.01 (0.83–1.24) |
| ≥1 h/day | 901 | 80,596 | 1.09 (0.97–1.23) | 1.08 (0.95–1.22) | 438 | 1.02 (0.86–1.21) | 463 | 1.16 (0.96–1.40) |
| Leisure-time exercise | ||||||||
| <1 h/week | 475 | 48,792 | 1.00 (reference) | 1.00 (reference) | 280 | 1.00 (reference) | 195 | 1.00 (reference) |
| 1 h/week | 562 | 57,124 | 1.01 (0.89–1.14) | 1.04 (0.91–1.17) | 335 | 1.02 (0.87–1.21) | 227 | 1.05 (0.89–1.14) |
| 2–3 h/week | 1137 | 111,350 | 1.03 (0.92–1.14) | 1.04 (0.93–1.16) | 616 | 1.04 (0.90–1.21) | 521 | 1.01 (0.92–1.14) |
| ≥4 h/week | 1222 | 117,073 | 1.11 (0.99–1.23) | 1.06 (0.95–1.19) | 554 | 1.12 (0.96–1.32) | 668 | 0.99 (0.83–1.17) |
| Sleep duration | ||||||||
| ≤6.0 h/night | 988 | 87,964 | 1.00 (0.92–1.09) | 0.99 (0.92–1.08) | 627 | 0.96 (0.86–1.07) | 361 | 1.05 (0.93–1.19) |
| 6.1–7.0 h/night | 1110 | 111,490 | 1.02 (0.94–1.10) | 1.01 (0.93–1.09) | 599 | 1.02 (0.91–1.14) | 511 | 1.00 (0.89–1.12) |
| 7.1–9.0 h/night | 1454 | 149,828 | 1.00 (reference) | 1.00 (reference) | 692 | 1.00 (reference) | 762 | 1.00 (reference) |
| >9.0 h/night | 119 | 7796 | 1.56 (1.30–1.88) | 1.54 (1.27–1.85) | 55 | 1.63 (1.24–2.14) | 64 | 1.44 (1.11–1.86) |
CI, confidence interval; HR, hazard ratio; DASH, Dietary Approaches to Stop Hypertension diet. aThe number of cases and person-years may not add up to the total number owing to missing data on some of the lifestyle factors. A dummy variable for missing was included in the model. bAdjusted for age, sex, education, body mass index, and history of hypertension, hypercholesterolemia and diabetes, and mutually for the other lifestyle factors (except the Mediterranean diet score due to strong correlation with the DASH diet score) and sleep duration. cThe number of cases included in the analysis of pack-years does not sum up to the number included in the analysis of smoking status owing to missing information on pack-years.