Public awareness and knowledge of factors associated with dementia in China

doi:10.21203/rs.2.24867/v1

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Public awareness and knowledge of factors associated with dementia in China

https://doi.org/10.21203/rs.2.24867/v1

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published 17 Oct, 2020

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Background Dementia is a global public health priority. Many modifiable factors have been shown to influence the development of dementia, but these factors are not adequately known by the general public. This study assessed public awareness of the factors that are associated with dementia among the general population in China.

Methods A cross-sectional study was conducted from May to October 2019 using an Internet-based questionnaire. We collected basic sociodemographic characteristics and investigated participants’ knowledge of risk and protective factors that are associated with dementia. The primary outcome measures were the proportions of participants who identified each option as a risk or protective factor. Logistic regression analysis was performed to compare levels of the knowledge of factors that are associated with dementia across populations with different demographic characteristics.

Results Data from a total of 3,338 respondents were analyzed. The percentages of participants who accurately identified dementia risk factors were the following: 84.24% for negative affect, 65.07% for alcohol use, 56.68% for smoking, 48.74% for hypertension, and 42.66% for diabetes. The percentages of participants who accurately identified dementia protective factors were the following: 90.00% for exercise, 84.69% for social activity, 80.92% for intelligence games, 74.45% for reading, and 6.14% for antihypertensive or hypolipidemic drugs. The majority of Chinese people correctly recognized the role of lifestyle factors in the development of dementia but not medical factors. Levels of knowledge of the factors that are associated with dementia were significantly distinct across populations with different characteristics. The following sociodemographic characteristics were associated with more comprehensive knowledge of dementia risk and protective factors: women, young age, high education levels, white-collar jobs, and contact with individuals with dementia.

Conclusions Public awareness and knowledge of risk and protective factors for dementia in China are still insufficient. More efforts are needed to publicize information about dementia to reduce risk and prevent dementia.

Neurology

Public awareness

understanding

dementia

factors

China

Dementia is an enormous global health problem. According to the 2016 Global Burden of Disease Study, approximately 43.8 million people lived with dementia worldwide in 2016[1]. Moreover, this number is estimated to increase to 75 million by 2030, and the majority of these individuals will likely come from low- and middle-income countries[2]. Unfortunately, to date, no treatments are available to cure dementia or alter its progressive course. Preventing dementia has become crucial. Evidence shows that immutable factors (e.g., genetics and aging), lifestyle, and environmental variables play important roles in the progression of dementia[3]. Thus, identifying and avoiding exposure to these modifiable risk factors may facilitate the prevention of dementia[4, 5] and help reduce disease burden that is associated with dementia[6, 7]. Numerous studies have explored the factors that influence the development of dementia. Accumulating evidence suggests that people with unhealthy habits, such as smoking[8] and excessive alcohol intake[9], or having depression[10, 11] and chronic diseases (e.g., diabetes mellitus[12] and hypertension[13]), may have a higher risk of developing dementia. Leisure activities, including physical exercise[14], cognitive training[15-17], and social activities[18, 19], may reduce the risk of developing dementia. Notably, however, although various risk and protective factors for dementia have been identified, they have not been adequately popularized and recognized among the general public. For example, a systematic review assessed knowledge and attitudes about dementia prevention and treatment and found that public knowledge about the modifiable nature of dementia prevention remained inadequate, although this situation might improve over time[20]. A recent survey from the Netherlands showed that the majority of community-dwelling people were unaware of the relationship between lifestyle and brain health[21]. Most investigations of knowledge and attitudes about dementia prevention have been conducted in high-income countries. Levels of knowledge of the potential for dementia prevention among individuals who live in other countries, such as China, are largely unknown[20].

Life expectancies have risen sharply over recent decades, and dementia is a serious health problem in China. The age-standardized prevalence of dementia in China increased by 5.6% in China from 1990 to 2016, while the worldwide prevalence increased by only 1.7%[1]. The estimated number of cases of dementia and total annual costs that are associated with dementia in China were predicted to reach 24.25 million people and USD$114.2 billion in 2030[22, 23]. The worldwide costs that are associated with Alzheimer’s dementia accounted for 1.09% of the global gross domestic product, whereas such costs accounted for 1.47% in China, indicating that the burden of dementia is even higher in China compared with the world average[24]. Thus, effective measures are needed to facilitate dementia prevention and reduce disease burden that is caused by dementia in China[25]. However, insufficient awareness and knowledge of the potential of dementia prevention among the Chinese public has been a substantial obstacle[25]. Some studies evaluated the Chinese population’s overall understanding of dementia, suggesting that the recognition of dementia needs to be improved[26, 27]. The awareness of specific protective and risk factors that are associated with dementia among the Chinese population is deficient. To identify specific target populations and develop strategies for dementia prevention, a better understanding of these factors is needed in populations with different sociodemographic backgrounds.

Study design and subjects

An online questionnaire that evaluated general knowledge of dementia was disseminated via WeChat (i.e., a social media outlet that is widely used in China) from May 27, 2019, to October 6, 2019. We invited Chinese individuals who lived in mainland China to complete the questionnaire. The study was approved by the Institutional Review Board of Peking University Sixth Hospital. The surveys that were used in this study could be answered anonymously, and participation was voluntary. Thus, consent was assumed by the voluntary choice to participate. We collected a total of 3,436 questionnaires. Incomplete questionnaires were excluded. A total of 3,338 questionnaires were available for analysis.

Questionnaire content

The questionnaire was written in Chinese and included two parts: (1) basic sociodemographic information, including gender, age, education level, type of job, income, type of residence, and whether the respondent had contact with anyone who lived with dementia, and (2) the following multiple-choice questions: “Which factors do you think can increase the risk of dementia?” “Which factors do you do think can reduce the risk of dementia?” The questions had the following response options: exercise, smoking, alcohol use, reading, intelligence games, social activity, hypertension, diabetes, negative affect (e.g., anxiety and depression), antihypertensive or hypolipidemic drugs, and “none of the factors mentioned above.” Among the options, hypertension, diabetes, negative affect, smoking, and alcohol use were regarded as risk factors based on previous findings, and the other options were protective factors. The questionnaire took approximately 3 min to complete.

Statistical analysis

Frequency distributions of all sociodemographic characteristics and the proportion of participants who identified each item as a risk or protective factor were calculated. We conducted multiple logistic regression analysis to compare the knowledge of factors for each item, stratified by demographic variables. We calculated odds ratios (ORs) and 95% confidence intervals (CIs). SPSS 22 software (SPSS, Chicago, IL, USA) was used to analyze the data. Values of p < 0.05 were considered statistically significant.

Characteristics of the subjects

In the present study, data from 3,338 eligible samples were analyzed. Table 1 shows the demographic characteristics of the respondents (1,154 males and 2,184 females). The average age was 39.23 ± 12.50 years. The proportions of different education levels, including primary school or illiteracy, middle school, college or university, and postgraduate education, were 1.71%, 18.51%, 50.00%, and 29.78%, respectively. A majority of the subjects were white-collar workers (77.29%) with income of 2000-10000 yuan per month (66.12%) and lived in cities (86.70%). Nearly one-third of the participants reported that they previously had contact with someone with dementia.

Awareness and understanding of dementia risk factors

The proportions of each item that was identified by the respondents as a risk factor for dementia are presented in Fig. 1. Most of the participants were able to correctly recognize at least one risk factor, but 5.51% of them were unable to correctly recognize any single risk factor. The percentages of the participants who accurately identified the following risk factors for dementia were 84.24% for negative affect, 65.07% for alcohol use, 56.68% for smoking, 48.74% for hypertension, and 42.66% for diabetes.

We next assessed the relationship between sociodemographic characteristics and knowledge of dementia risk factors using multiple logistic regression analysis (Table 2). Compared with men, more women believed negative affect (OR = 1.68, 95% CI = 1.37-2.05) was a risk factor for dementia. The age-specific analysis found that middle-aged individuals (40-65 years old) were significantly less likely to identify the contribution of negative affect (OR = 0.69, 95% CI = 0.56-0.86), alcohol use (OR = 0.83, 95% CI = 0.71-0.99), and smoking (OR = 0.67, 95% CI = 0.57-0.79) to the progression of dementia compared with younger individuals (< 40 years old), indicating that the older age group might have lower levels of knowledge of dementia risk factors. Additionally, the group with a higher level of education (college, university, and postgraduate education) had a better understanding of all five dementia risk factors.

In addition to gender, age, and education level, the type of job and contact with people with dementia also influenced the awareness of dementia risk factors. Blue-collar workers had a poorer understanding of the relationship between smoking and dementia (OR = 0.75, 95% CI = 0.59-0.96) compared with white-collar workers, and retired people had an insufficient understanding of all dementia risk factors. Respondents who were never in contact with individuals with dementia were less likely to realize the roles that negative affect (OR = 0.73, 95% CI = 0.59-0.91), alcohol use (OR = 0.72, 95% CI = 0.61-0.86), smoking (OR = 0.77, 95% CI = 0.66-0.91), and diabetes (OR = 0.63, 95% CI = 0.54-0.74) play in the development and progression of dementia. The awareness of risk factors for dementia was not influenced by income or type of residence.

Awareness and understanding of dementia protective factors

Fig. 2 shows the proportions that participants who identified each item as a protective factor for dementia. The proportion of participants who chose none of the five items as protective factors was 4.79%. Most of the respondents correctly recognized exercise (90.00%), social activity (84.69%), intelligence games (80.92%), and reading (74.45%) as protective factors. However, only 6.14% of the individuals were aware that taking antihypertensive or hypolipidemic drugs was beneficial for delaying the onset of dementia. Multiple logistic regression analysis was used to explore the effects of sociodemographic characteristics on the understanding of protective factors of dementia (Table 3). Gender, age, education level, type of job, and contact with individuals with dementia had distinct influences on the awareness of protective factors for dementia. Income and type of residence did not influence the awareness of protective factors for dementia.

Compared with men, women knew more about the roles of exercise (OR = 1.33, 95% CI = 1.04-1.72), social activity (OR = 1.92, 95% CI = 1.57-2.35), intelligence games (OR = 2.21, 95% CI = 1.82-2.69), and reading (OR = 1.96, 95% CI = 1.65-2.33) in preventing dementia. Compared with younger individuals (< 40 years old), middle-aged subjects and elderly individuals were less aware that exercise (40-65 years old: OR = 0.60, 95% CI = 0.45-0.79; ≥ 65 years old: OR = 0.41, 95% CI = 0.23-0.72), intelligence games (40-65 years old: OR = 0.47, 95% CI = 0.38-0.58; ≥ 65 years old: OR = 0.43, 95% CI = 0.26-0.72), and reading (40-65 years old: OR = 0.79, 95% CI = 0.65-0.95; ≥ 65 years old, OR = 0.51, 95% CI = 0.31-0.83) were protective factors. People with a higher level of education had a better understanding of lifestyle variables that were protective factors for dementia, with the exception of antihypertensive and hypolipidemic drugs. Compared with white-collar workers, blue-collar workers had lower knowledge that exercise (OR = 0.64, 95% CI = 0.45-0.92) and reading (OR = 0.70, 95% CI = 0.53-0.91) were protective factors. Individuals who had contact with individuals with dementia had a better understanding that social activity and reading were protective factors for dementia. Only people who had contact with someone who lived with dementia knew that antihypertensive and hypolipidemic drugs might help prevent dementia.

The present study investigated public knowledge and awareness of the factors that are associated with dementia in China using a relatively large sample. We found that Chinese people had an extensive but not a comprehensive understanding of dementia. Most people could correctly recognize evidence-based risk and protective factors. However, a majority of the respondents were unaware of the role of medical factors in the development of dementia. Additionally, the understanding of factors that are related to dementia was significantly associated with sociodemographic variables, such as gender, age, education level, type of job, and contact with individuals with dementia. These findings underscore the necessity to expend more effort to promote the public knowledge of dementia in China and develop different strategies for people with different backgrounds.

Previous studies suggested that knowledge of the possibility that dementia can be prevented remains poor in general. A few studies that were conducted in China mainly focused on the recognition of prodromal symptoms of dementia[20, 26]. The present results suggest that the overall understanding of factors that are associated with dementia among the Chinese population is more comprehensive than we initially believed based on similar studies in other countries[21, 28, 29]. This finding may have two explanations. First, the respondents in the present study had a relatively high level of education and may be able to absorb more accurate information about dementia. Second, we used an online questionnaire and invited people to participate through the Internet, suggesting that our respondents may have better access to information about brain health compared with the general public. Future studies should compare the public’s awareness of dementia between China and other countries and evaluate the role of the Internet in disseminating brain health information.

The factors that are associated with dementia and were used as response options in the present study can be divided into two categories: lifestyle factors and medical factors[30]. Most of the respondents correctly recognized the relationship between lifestyle factors (e.g., alcohol use, smoking, and leisure activities) and dementia, but they often misunderstood the contribution of medical conditions and certain medications to the development of dementia. This may be explained by the fact that the publicity of disease prevention mainly focuses on lifestyle elements[31, 32], thus neglecting the fact that chronic diseases, including hypertension and diabetes, are risk factors for dementia[17]. Moreover, medication refusal is common in the general population[33], and people are often more concerned about the side effects of antihypertensive and hypolipidemic drugs than their beneficial effects[34]. Other studies also found that people had less knowledge about the role of cardiovascular disease management in the development of dementia[21, 35]. Thus, medical factors that are associated with the prevention of dementia need to be popularized in the general public.

Several sociodemographic characteristics were independently associated with the knowledge of dementia risk and prevention factors. Several characteristics, including women, age < 40 years, a high level of education, white-collar job, and having contact with individuals with dementia, were associated with a more extensive understanding of dementia, which is partially consistent with previous surveys that were conducted in China[27, 36]. Women often have a better understanding of dementia in both China and other countries[27, 35, 37]. Individuals with a high level of education or previous contact with dementia patients had significantly better knowledge of risk and protective factors for dementia[36, 38], which may be attributable to a higher probability of accessing information about dementia. In the present study and another survey that was conducted in Asia[39], younger people had more knowledge about dementia than middle-aged and elderly individuals. These findings suggest the need to develop different approaches for different populations to disseminate knowledge about dementia. Because the present study had a limited number of subjects who had an income < 2000 yuan/month and who were from rural areas, no significant influence of income or type of residence was found. Future studies should include more subjects who have a lower income and who are from rural areas.

The strengths of the present study include (1) investigating the knowledge of risk and protective factors for dementia in a relatively large sample of the Chinese population and (2) exploring demographic characteristics that are associated with the level of knowledge of dementia. Informing the public about modifiable risk and protective factors may help reduce the incidence of dementia.

The present study also has several limitations. First, selection bias might have been unavoidable because of the use of an Internet-based social media application (i.e., WeChat). Second, we used simple idioms instead of professional terms so that the response options could be more easily understood by the general public, which may have caused some ambiguity. Third, the response options that were used were not comprehensive, and other factors that are associated with dementia (e.g., unhealthy diet and obesity) were not assessed.

In summary, the present Internet-based survey demonstrated substantial deficits in the public knowledge of modifiable factors for dementia in China. People with different characteristics may have distinct awareness of dementia risk. These findings indicate the importance of disseminating information about dementia in China and educating the public about the role of modifiable risk and preventive factors. More information about dementia risk reduction should be delivered to the public, and different promotion strategies are needed to achieve prevention.

OR: Odds ratio; CI: Confidence interval

Acknowledgments

We want to acknowledge all the study participants and data collectors for their willingness to participate in this study.

Authors’ contributions

YZ and LS developed the proposal and designed the protocol, JQ and LL were involved in revising the proposal and design. YZ, LS, XW, DL, and YB were involved in data collection, and analyzation. YZ and YG drafted the manuscript, LS, MZK and LL revised the analysis and help the preparation of the manuscript. All the authors have read and approved the final version of the manuscript.

Funding

This work was supported by the Beijing Natural Science Foundation (no. 7194336) and Natural Science Foundation of China (no. 31900805). The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the manuscript. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Availability of data and materials

The primary data set collected from households and analyzed during the current study is available from the corresponding author.

Ethics approval and consent to participate

The study procedure was reviewed and approved by the Peking University Sixth Hospital natural and computational science research and community service reviewers. All information obtained in the study was kept confidential.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Author details

1 Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China

2 Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China

3 Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China

4 National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China

5 Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China; National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China; Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China.

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Table 1. Characteristics of the participants.

	Number	Weighted proportion
Gender
Men	1154	34.57%
Women	2184	65.43%
Age (years)
< 40	1845	55.27%
40-65	1387	41.55%
≥ 65	106	3.18%
Education level
Primary school or illiteracy	57	1.71%
Middle or high school	618	18.51%
College or university	1669	50.00%
Postgraduate	994	29.78%
Type of job
White-collar	2580	77.29%
Blue-collar	405	12.13%
Retired	353	10.58%
Income group (yuan/month)
0-2000	366	10.96%
2000-5000	978	29.30%
5000-10000	1229	36.82%
> 10000	765	22.92%
Type of residence
City	2894	86.70%
Town	290	8.69%
Rural area	154	4.61%
Dementia contact
Yes	1101	32.98%
No	1676	50.21%
Unclear	561	16.81%

Table 2. Demographic and social factors associated with knowledge of risk factors for dementia.

	Negative affect			Alcohol use			Smoking			Hypertension			Diabetes
	%	OR	95% CI	%	OR	95% CI	%	OR	95% CI	%	OR	95% CI	%	OR	95% CI
Gender
Men	80.80	1		64.60	1		55.10	1		48.70	1		41.80	1
Women	86.10	1.68*	1.37-2.05	65.30	1.10	0.94-1.29	57.50	1.14	0.98-1.33	48.80	1.06	0.91-1.23	43.10	1.10	0.95-1.28
Age (years)
< 40	87.70	1		69.40	1		63.30	1		52.00	1		45.70	1
40-65	80.00	0.69*	0.56-0.86	60.60	0.83*	0.71-0.99	49.20	0.67*	0.57-0.79	45.60	0.89	0.76-1.05	39.70	0.92	0.78-1.08
≥ 65	79.20	1.19	0.67-2.11	48.10	0.79	0.50-1.25	38.70	0.64	0.40-1.02	34.00	0.80	0.50-1.29	29.20	0.90	0.55-1.47
Education level
Primary school or illiteracy	59.60	1		38.60	1		31.60	1		29.80	1		17.50	1
Middle or high school	73.50	2.02*	1.13-3.60	49.70	1.58	0.89-2.78	40.30	1.41	0.78-2.54	32.70	1.10	0.60-2.01	26.50	1.57	0.77-3.21
College or university	86.80	3.78*	2.07-6.89	67.20	2.61*	1.47-4.66	59.30	2.25*	1.24-4.10	50.90	1.99*	1.08-3.64	44.20	2.81*	1.37-5.75
Postgraduate	88.10	3.69*	1.95-6.97	72.60	3.13*	1.72-5.70	63.90	2.47*	1.33-4.57	56.10	2.24*	1.2-4.17	51.60	3.51*	1.69-7.30
Type of job
White-collar	86.70	1		69.20	1		61.00	1		52.40	1		46.60	1
Blue-collar	78.50	0.95	0.69-1.31	54.60	0.78	0.61-1.00	45.20	0.75*	0.59-0.96	38.30	0.84	0.66-1.08	30.10	0.78	0.60-1.01
Retired	72.80	0.55*	0.39-0.76	46.70	0.56*	0.43-0.74	38.20	0.60*	0.45-0.79	34.30	0.67*	0.51-0.90	28.60	0.62*	0.46-0.84
Income groups (yuan/month)
0-2000	80.60	1		59.60	1		54.60	1		42.30	1		37.40	1
2000-5000	82.40	1.09	0.79-1.51	60.80	1.08	0.83-1.40	53.00	0.95	0.73-1.23	45.20	1.14	0.88-1.47	38.80	1.06	0.82-1.38
5000-10000	84.40	0.96	0.69-1.34	67.20	1.13	0.87-1.47	58.90	0.95	0.74-1.23	48.90	1.06	0.83-1.37	43.50	1.01	0.78-1.30
> 10000	88.10	1.35	0.92-1.97	69.70	1.13	0.85-1.51	58.80	0.88	0.66-1.16	56.10	1.30	0.99-1.71	48.80	1.11	0.84-1.47
Type of residence
City	87.70	1		65.80	1		58.10	1		49.90	1		44.20	1
Town	79.70	0.90	0.65-1.25	62.10	1.13	0.86-1.47	48.30	0.84	0.65-1.09	42.10	0.93	0.72-1.20	34.80	0.88	0.67-1.15
Rural area	75.30	0.79	0.52-1.21	57.10	1.09	0.76-1.56	46.10	0.86	0.60-1.23	39.00	0.97	0.68-1.39	27.90	0.76	0.52-1.12
Dementia contact
Yes	85.90	1		69.10	1		59.20	1		54.20	1		48.50	1
No	82.80	0.73*	0.59-0.91	62.90	0.72*	0.61-0.86	55.00	0.77*	0.66-0.91	45.00	0.67	0.57-0.78	38.10	0.63*	0.54-0.74
Unclear	85.20	1.00	0.74-1.35	63.60	0.82	0.65-1.02	56.70	0.91	0.73-1.12	49.20	0.86	0.70-1.06	44.70	0.92	0.74-1.13

Table 3. Demographic and social factors associated with knowledge of protective factors for dementia.

	Exercise			Social activity			Intelligence games			Reading			Antihypertensive or hypolipidemic drugs
	%	OR	95% CI	%	OR	95% CI	%	OR	95% CI	%	OR	95% CI	%	OR	95% CI
Gender
Men	89.17	1		79.55	1		74.61	1		66.72	1		6.41	1
Women	90.43	1.33*	1.04-1.72	87.41	1.92*	1.57-2.35	84.25	2.21*	1.82-2.69	78.66	1.96*	1.65-2.33	6.00	0.91	0.68-1.24
Age (years)
< 40	93.60	1		87.37	1		88.40	1		78.86	1		6.88	1
40-65	86.52	0.60*	0.45-0.79	82.26	0.82	0.65-1.02	72.60	0.47*	0.38-0.58	70.37	0.79*	0.65-0.95	5.26	0.77	0.55-1.07
≥ 65	72.64	0.41*	0.23-0.72	69.81	0.54	0.32-0.92	59.43	0.43*	0.26-0.72	53.77	0.51*	0.31-0.83	4.72	0.30	0.30-2.41
Education level
Primary school or illiteracy	64.91	1		56.14	1		35.09	1		40.35	1		3.51	1
Middle or high school	80.42	2.26*	1.23-4.13	73.30	2.12*	1.19-3.76	60.52	3.19*	1.76-5.80	55.50	1.82*	1.03-3.21	3.88	0.99	0.22-4.37
College or university	91.19	3.62*	1.91-6.85	85.68	3.70*	2.04-6.72	84.66	7.75*	4.18-14.36	77.77	4.14*	2.30-7.43	6.47	1.40	0.32-6.20
Postgraduate	95.37	5.47*	2.68-11.15	91.75	6.37*	3.35-12.12	89.94	11.21*	5.82-21.59	82.90	5.38*	2.92-9.93	7.14	1.49	0.33-6.77
Type of job
White-collar	93.02	1		87.36	1		85.54	1		78.57	1		6.67	1
Blue-collar	82.47	0.64*	0.45-0.92	74.07	0.75	0.56-1.02	68.89	0.85	0.63-1.14	58.77	0.70*	0.53-0.91	4.20	0.76	0.43-1.35
Retired	76.49	0.53*	0.36-0.77	77.34	0.86	0.60-1.23	60.91	0.57*	0.42-0.79	63.17	0.80	0.59-1.08	4.53	0.82	0.43-1.54
Income groups (yuan/month)
0-2000	86.61	1		80.33	1		75.68	1		70.49	1		6.01	1
2000-5000	86.50	1.02	0.70-1.48	82.31	1.21	0.87-1.66	75.56	1.01	0.73-1.38	71.78	1.03	0.78-1.38	5.62	1.00	0.59-1.70
5000-10000	90.97	1.15	0.77-1.72	85.68	1.18	0.85-1.65	84.95	1.29	0.93-1.80	76.00	0.95	0.71-1.27	6.67	0.99	0.60-1.64
> 10000	94.51	1.61	0.99-2.63	88.24	1.31	0.90-1.92	83.79	1.04	0.72-1.51	77.65	0.98	0.71-1.36	6.01	0.82	0.47-1.43
Type of residence
City	90.50	1		85.83	1		82.38	1		76.09	1		6.46	1
Town	88.62	1.32	0.87-1.98	77.93	0.89	0.64-1.22	74.83	1.07	0.78-1.46	68.28	1.02	0.77-1.36	3.10	0.51	0.25-1.03
Rural area	83.12	1.01	0.61-1.66	75.97	1.04	0.68-1.61	64.94	0.78	0.52-1.18	57.14	0.81	0.56-1.18	5.84	1.11	0.53-2.33
Dementia contact
Yes	91.19	1		87.19	1		82.02	1		77.20	1		8.27	1
No	90.21	0.84	0.64-1.11	84.19	0.78*	0.62-0.98	81.68	0.89	0.72-1.10	73.75	0.81*	0.67-0.98	4.47	0.49*	0.35-0.67
Unclear	86.99	0.71*	0.50-0.99	81.28	0.70*	0.53-0.94	76.47	0.74*	0.56-0.97	71.66	0.81	0.64-1.04	6.95	0.82	0.55-1.21

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Public awareness and knowledge of factors associated with dementia in China

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