Impacts of Illiteracy on the Risk of Dementia: A Global Health Perspective

Article type: Research Article

Authors: Suh, Seung Wan^a | Han, Ji Won^b | Park, Jae Young^b | Hong, Jong Woo^b | Kim, Kayoung^b | Kim, Taehyun^b | Lee, Kyoung Hwan^b | Han, Guehee^b | Jeong, Hyeon^c | Seo, Jiyeong^d | Kim, Tae Hui^e | Lee, Dong Young^{a; f} | Lee, Dong Woo^g | Ryu, Seung-Ho^h | Kim, Shin-Gyeomⁱ | Youn, Jong Chul^j | Jhoo, Jin Hyeong^k | Kim, Jeong Lan^l | Lee, Seok Bum^m | Lee, Jung Jae^m | Kwak, Kyung Philⁿ | Kim, Bong-Jo^o | Moon, Seok Woo^p | Park, Joon Hyuk^q | Kim, Ki Woong^{b; f; r; *}

Affiliations: [a] Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea | [b] Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea | [c] Department of Psychiatry, Woori-Seongsim Psychiatric Clinic, Siheung, Korea | [d] Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Korea | [e] Department of Psychiatry, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea | [f] Department of Psychiatry, Seoul National University, College of Medicine, Seoul, Korea | [g] Department of Neuropsychiatry, Inje University Sanggye Paik Hospital, Seoul, Korea | [h] Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Korea | [i] Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Korea | [j] Department of Neuropsychiatry, Gyeonggi Provincial Hospital for the Elderly, Yongin, Korea | [k] Department of Neuropsychiatry, Kangwon National University Hospital, Chuncheon, Korea | [l] Department of Psychiatry, Chungnam National University Hospital, Daejeon, Korea | [m] Department of Psychiatry, Dankook University Hospital, Cheonan, Korea | [n] Department of Psychiatry, Dongguk University Gyeongju Hospital, Gyeongju, Korea | [o] Department of Psychiatry, Gyeongsang National University, School of Medicine, Jinju, Korea | [p] Department of Psychiatry, Konkuk University, School of Medicine, Chungju, Korea | [q] Department of Neuropsychiatry, Jeju National University Hospital, Jeju, Korea | [r] Department of Brain and Cognitive Sciences, Seoul National University, College of Natural Sciences, Seoul, Korea

Correspondence: [*] Correspondence to: Ki Woong Kim, MD, PhD, Department of Neuropsychiatry, Seoul National University, College of Medicine, and Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si 463-707, Republic of Korea. Tel.: +82 31 787 7432; Fax: +82 31 787 4058; E-mail: [email protected].

Abstract: Despite its significance as a contributing factor for late-life dementia risk, illiteracy is frequently underappreciated in the management of dementia. In this study, we estimated the proportion of dementia cases attributable to illiteracy using the population attributable fraction (PAF), and calculated to what extent the monetary cost of dementia could be saved in the future by reducing illiteracy from the South Korean, Latin American, South Asian/Middle Eastern, and African populations. We collected necessary data from the 2011 United Nations Human Development Report and prevalence studies conducted in these regions. Additional variables not included in the above sources were estimated using a logit model under a “trend scenario”-based assumption. Around 16% of the total number of dementia cases in South Korea in 2015 can be attributed to illiteracy, with this figure predicted to decline to around 2% by 2050. This translates to a saving in dementia care costs of approximately 52 billion USD, providing we are successful in theoretically eradicating illiteracy as of 2015, in the population aged 65 years or under. Likewise, reducing illiteracy to 50% in Latin America, South Asia/The Middle East, and Africa by 2050 could generate further cost savings of between 71 and 244 billion, 13 and 94 billion, and 17 and 78 billion USD, respectively. Even public policies aimed solely at reducing illiteracy in the childhood, adolescent, or middle-aged population could potentially have a role in the primary prevention of dementia. Moving forward, governments will need to address this issue in a purposeful and systematic manner.

Keywords: Africa, cognitive reserve, dementia, dementia care costs, health expenditure, Latin America, literacy, population attributable fraction, Republic of Korea

DOI: 10.3233/JAD-160108

Journal: Journal of Alzheimer's Disease, vol. 53, no. 2, pp. 731-741, 2016