“ Adverse SDOH was associated with higher dementia risk, with stronger T2D-related risk among medium/unfavorable SDOH groups, especially in women with T2D .”
BUFFALO, NY — October 1, 2026 — A new research paper was published in Volume 18 of Aging on September 10, 2026, titled “ Social determinants of health and risk of dementia in people with and without type 2 diabetes – findings from two large national-scale cohorts .”
The study found that unfavorable social determinants of health (SDOH) were associated with a higher risk of dementia in adults with and without type 2 diabetes (T2D), with particularly strong associations observed among women with T2D.
The research was authored by You Lu and Yilin Yoshida. Both researchers are affiliated with the Section of Endocrinology, Deming Department of Medicine, Tulane University, New Orleans, Louisiana .
People with T2D already face an elevated risk of dementia and cognitive impairment. The researchers examined whether social and environmental circumstances could further shape this risk. Rather than evaluating individual social factors separately, they developed a weighted multidomain SDOH score designed to capture the cumulative and unequal contributions of multiple forms of social disadvantage.
The primary analysis included 10,071 UK Biobank participants with T2D and 11,780 euglycemic participants. SDOH indicators were weighted using an elastic-net approach and grouped into favorable, medium and unfavorable categories. Associations with incident dementia were examined using multivariable models and further evaluated using data from the U.S. All of Us Research Program.
Over approximately 14 years of follow-up in the UK Biobank, 247 participants with T2D and 149 euglycemic participants developed dementia. Among people with T2D, unfavorable versus favorable SDOH was associated with approximately a 2.4-fold higher hazard of dementia. A similar overall association was observed among euglycemic participants, indicating that cumulative social disadvantage was also associated with dementia risk in people without diabetes.
The association was particularly strong among women with T2D. Unfavorable versus favorable SDOH was associated with a 1.7-fold higher dementia risk in men with T2D and a 5.35-fold higher risk in women. The sex interaction was statistically significant, indicating that the association between SDOH burden and dementia risk differed between men and women with T2D.
Diabetes-related dementia risk also varied across social environments. Among participants with medium or unfavorable SDOH, those with T2D had nearly three times the hazard of dementia compared with euglycemic participants. Among women in these categories, T2D was associated with approximately a 3.1-fold higher risk compared with euglycemic women. Similar patterns for dementia and mild cognitive impairment were observed in the All of Us cohort.
Individual SDOH components associated with dementia among UK Biobank participants with T2D included household income, area-level education deprivation, home ownership, loneliness and perceived stress. Household income and loneliness were associated with dementia risk in both men and women, with stronger associations in women, while perceived stress was additionally associated with dementia risk in women with T2D.
The authors discuss several pathways that could contribute to these patterns. Social disadvantage can affect access to healthcare, healthy food, physical activity, medication adherence and diabetes self-management while increasing psychosocial stress. These factors could interact with vascular and metabolic abnormalities associated with T2D, including microvascular disease, endothelial dysfunction, chronic inflammation and insulin resistance. However, the observational findings do not establish that adverse SDOH directly cause dementia.
“ Overall, findings from our study support the evidence that women with T2D may be especially vulnerable to the cognitive consequence of SDOH. ”
The study has important limitations. Dementia and mild cognitive impairment were identified using diagnostic codes, which can result in misclassification or missed undiagnosed cases. SDOH measures differed between the UK Biobank and All of Us and required harmonization, neither cohort fully represents the general population, and residual confounding cannot be excluded. Neuroimaging and cognitive measures were also cross-sectional, limiting mechanistic interpretation.
Future studies incorporating longitudinal brain imaging, repeated cognitive assessments, inflammatory markers, proteomics and metabolomics could help clarify how social disadvantage relates to cognitive decline.
Overall, the findings indicate that cumulative social conditions are associated with dementia risk and may be particularly important among people with T2D. The stronger association observed among women with T2D highlights the potential value of considering both social circumstances and sex in cognitive risk assessment and diabetes care, while further research is needed to determine whether interventions addressing adverse SDOH can reduce dementia risk.
Paper DOI : https://doi.org/10.18632/aging.206417
Corresponding author: Yilin Yoshida - yyoshida1@tulane.edu
Abstract video: https://www.youtube.com/watch?v=Aql6kZZDrEI
Keywords: aging, dementia, SDOH, type 2 diabetes, sex difference
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Social determinants of health and risk of dementia in people with and without type 2 diabetes – findings from two large national-scale cohorts
10-Sep-2026
The authors declare that they have no conflicts of interest.