INEQUITY IN MINDOn the Social and Genetic Risk Factors of Dementia and Their Interactions

Caroline Hasselgren

119450_GU_Caroline_Hasselgren_omslag_190909.indd 1 2019-09-09 08:52:31

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Healthy Alzheimer’s disease

Amyloid plaques

Neurofibrillary tangles

Neuron

Enlargementof ventricles

Shrinkageof Cortex

Shrinkage ofHippocampus

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\5! (-$!#1;$! ';@2'$5I! (-$!1%85&-"*'b,-:%.#(,%$%[),5/5#-"/! 155$8(5! (-1(!-$12(-!+'5@18'('$5!18'5$!15!1!0/#5$%&$#0$!/9!+'55';'218'('$5!'#!D$-1C'/&8!D$(Q$$#!+'99$8$#(!5/0'12!?8/&@5R!7/8!$K1;@2$I! '(! -15! 8$@$1($+2)! D$$#! 5-/Q#! (-1(I! $R?RI! 5;/6'#?! 1#+!;12#&(8'('/#! 18$!;/8$!0/;;/#!'#!5/0'122)!+'51+C1#(1?$+!?8/&@5R!J$01&5$!such ‘behaviours’ are also influential +$($8;'#1#(5!/9!;/8(12'()!1#+!;/8D'+'()I! (-$5$!+'99$8$#0$5!18$!0/#5'+$8$+! (/! 9/8;!(-$!D15'5!/9!-$12(-!'#$%&'()R!=/#5$%&$#(2)I!(-'5!1@@8/10-!'5!5/;$(';$5!8$9$88$+!(/!15!(-$!'-.S$:56#"'$4"0%,!^d'#6!1#+![-$21#I!EFGF_R!A-'2$!5/0'12!01&51('/#!'5!'#+$$+!$;@-15'l$+!'#!(-'5!1@@8/10-I! '(! '5! &5&122)! 0/#0$@(&12'l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factors more ‘proximate’ to disease and thereby contributing to an ‘'#+'C'+&12'l1('/#’!/9!8'56!^=18($8I!EFGOu!M25(1+I!EFFFu!</Q#5$#+I!GHHF_R!!

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u!MC1#5I!GHHNu!*18;/(I!EFFN_R!<-&5I!'#!/8+$8!(/!9&22)!$K@21'#!-$12(-!'#$%&'()!1D/C$! (-$! (-8$5-/2+! /9! 1D5/2&($!;1($8'12! +$@8'C1('/#I! @8/@/#$#(5! /9! (-$! @5)0-/5/0'12!1@@8/10-!1+C/01($!9/0&5'#?!/#!individuals’ social environments. 7/8!'#5(1#0$I!'(!-15!D$$#!18?&$+!(-1(I!D$01&5$!-&;1#5!18$!'#-$8$#(2)!5/0'12!D$'#?5I!(-$)!Q'22!12Q1)5!8$21($!(/!(-$'8!5/0'12!$#C'8/#;$#(5I!Q-'0-!Q'22!'#!(&8#!$C/6$5!+'99$8$#(!@5)0-/2/?'012!8$10('/#5R!"#!2$55!1+C1#(1?$+!?8/&@5I!(-$5$!8$10('/#5!Q'22!@8$+'0(1D2)!0/;@8'5$!5(8$55!1#+!98&5(81('/#!(-1(I!+81Q'#?!/#!(-$!D$-1C'/&85Z2'9$5()2$!;/+$2I!$'(-$8!spur ‘unhealthy behaviours’ or trigger @-)5'/2/?'012! @8/0$55$5! (-1(! '#08$15$! +'5$15$! 5&50$@('D'2'()! ^$R?RI! -)@$8($#5'/#! /8!';;&#/5&@@8$55'/#_! ^*18;/(I! EFFNu! A'26'#5/#! 1#+! *18;/(I! EFFP_R! */8$/C$8I! 1#!individual’s 02155!@/5'('/#!'5!&5&122)!0/#5'+$8$+!02/5$2)!8$21($+!(/!-$8!."6-5,$65)-#5,! J/&8+'$&I!GHVNu!g1Q10-'!$(!12RI!GHHLu!4/5('21I!EFGP_R!A-'2$!5/0'12!01@'(12!0/&2+!D$!8$21($+!(/!122!/9!(-$!(-8$$!$K@21#1(/8)!(81+'('/#5!/&(2'#$+!1D/C$!^4/5('21I!EFGP_I!'(!+$5$8C$5!5/;$!1(($#('/#!-$8$!/Q'#?!(/!'(5!$;@-15'5!/#!(-$!5'?#'9'01#0$!/9!5/0'12!8$21('/#5-'@5R!"#!'(5!;/5(!D15'0!form, the notion of social capital ‘expresses the idea that there are tangible resources embedded in social relationships, available for members to access’ ^g1Q10-'! 1#+!J$86;1#I!EFGNY!EHGI!5$$!125/!Jn06I!EFGEu![/8($5I!EFFFu!4/5('21I!EFGG_R!\(!(-$!'#+'C'+&12!2$C$2I!@/($#('122)!-$12(-W@8/;/('#?!8$5/&80$5!/9!5/0'12!01@'(12!'#02&+$I!D&(!18$!#/(!2';'($+!

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(/I!10%&'5'('/#!/9!8$2$C1#(!'#9/8;1('/#!15!Q$22!15!9'#1#0'12!1#+!199$0('C$!5&@@/8(R!A-$#!'#5($1+!1#12)5$+!15!1!@8/@$8()!/9!1!Q-/2$!#$(Q/86I!5/0'12!01@'(12!;1)!$K$8(!'#92&$#0$!/#!(-$!-$12(-!/9!;$;D$85!(-8/&?-I!$R?RI!(81#5;'55'/#!/9!D$-1C'/&812!#/8;5!/8!;/D'2'l1('/#!/9!0/22$0('C$!10('/#!'#!(';$5!/9!08'5'5!^g1Q10-'!1#+!J$86;1#I!EFGNu!4/5('21I!EFGG_R!!

:$5@'($!(-$!?8/Q'#?!'#($8$5(!'#I!1#+!Q'+$!100$@(1#0$!/9I!@5)0-/5/0'12!$K@21#1('/#5!9/8!-$12(-!'#$%&'()!+&8'#?!8$0$#(!+$01+$5I!(-$!8$21('C$!$K@21#1(/8)!@/Q$8!/9!5&0-!910(/85!8$;1'#5!1!0/#($5($+!'55&$R!,#!(-$!/#$!-1#+I!C15(!$;@'8'012!$C'+$#0$!5&@@/8(5!(-$!'+$1!(-1(! -$12(-! +'5@18'('$5! 1D/C$! (-$! (-8$5-/2+! /9! 1D5/2&($! ;1($8'12! +$@8'C1('/#! ;&5(! D$!approached by attending to individuals’ social environments ^5$$I! $R?RI! *18;/(! 1#+!A'26'#5/#I!EFFGu!A'26'#5/#!1#+!['06$((I!EFFX_R!,#!(-$!/(-$8!-1#+I!12(-/&?-!@5)0-/5/0'12!910(/85!+/!'#+$$+!0/#(8'D&($!5'?#'9'01#(2)!(/!-$12(-I!15!+/!2'9$5()2$!1#+!;1($8'12!910(/85I!5/;$!5(&+'$5!-1C$!5-/Q#!(-1(!(-$'8!0/#(8'D&('/#!'5!?$#$8122)!;/+$5(!^\2+1D$!$(!12RI!EFGGu!d)#0-!$(!12RI!EFFGu!C1#!,/8(!$(!12RI!EFFO_R!

MK@21'#'#?!$K@21#1('/#5!–!7&#+1;$#(12!01&5$!(-$/8)i!<-$! 9&#+1;$#(12! 01&5$! (-$/8)! ^7=<_! /9! -$12(-! '#$%&'('$5! Q15! 9'85(! 9/8;&21($+! '#! (-$!GHHF5I!218?$2)!'#!/@@/5'('/#!(/!(-$!(-$#Wprevailing ’risk factor approach’ (see above) that @8$+/;'#1($+! '#!;&0-!/9! (-$!;$+'012!1#+!$@'+$;'/2/?'012! 8$5$180-! ^>/&5$I!EFFE_R!\5!'#+'01($+!'#!=-1@($8!"I!"!;1'#(1'#!(-1(!(-$!9/0&5!/#!'#+'C'+&12W2$C$2!8'56!910(/85!-15!D$$#!';;$#5$2)!'#92&$#('12!125/!'#!5(&+'$5!/9!+$;$#('1!–!1(!(-$!$K@$#5$!/9!1(($;@(5!(/!$K@21'#!Q-1(!&#'($5!(-$5$!910(/85R!!

\00/8+'#?!(/!d'#6!1#+![-$21#!^EFGFY!P_, the risk factor approach ‘[…] precedes acW0/8+'#?!(/!1!5$$;'#?2)!@$85&15'C$!2/?'0Y!5/0'12!0/#+'('/#5!18$!8$21($+!(/!-$12(-!D$01&5$!/9!(-$'8!'#92&$#0$!/#!1!-/5(!/9!8'56!910(/85!(-1(!2'$!D$(Q$$#!f(-$;h!1#+!+'5$15$!'#!1!0-1'#!/9!causality’. Following this line of thought, interventions targeting intermediate, modifiable 8'56!910(/85!18$!0/#5'+$8$+!6$)!(/!8$;$+)'#?!-$12(-!'#$%&'('$5R!>/Q$C$8I!(-'5!2/?'0!0/;$5!&@!5-/8(!'#!@18('0&2182)!/#$!15@$0(Y!#1;$2)!(-1(!(-$!155/0'1('/#!D$(Q$$#!5/0'12!@/5'('/#!1#+!-$12(-!-/2+5!9/8!1!Q'+$!81#?$!/9!+'5$15$5!1#+!8$;1'#5!5(1D2$!/C$8!(';$I!'R$RI!$C$#!Q-$#!'#($8C$#'#?!;$0-1#'5;5! C18)!/8! 0-1#?$! 0/;@2$($2)! ^d'#6! 1#+![-$21#I! GHHOu!d'#6! 1#+![-$21#I! EFGFu! [-$21#! $(! 12RI! EFFN_R! [&D2'0! -$12(-! @/2'0'$5! (-1(! 9/0&5! /#! @8/C'+'#?! '#W9/8;1('/#!/#!8'56Z@8/($0('C$!910(/85!Q'22!#/(!5&99'0$!(/!$81+'01($!-$12(-!'#$%&'('$5!'#5/918!as they do not also target factors that influence individuals’ possibilities to, e.g., acquire #$Q!6#/Q2$+?$!/8!;16$!&5$!/9!#$Q!($0-#/2/?'$5!^d'#6!1#+![-$21#I!EFGF_R!./0'12!'#$%&'()!;&5(!(-$8$9/8$I!'(!'5!18?&$+I!D$!8$?18+$+!15!1!:*/054%/#5,$01&5$$/9!+'5$15$!–!5';@2)!D$01&5$!(-$!;/8$!1992&$#(!Q'22!12Q1)5!-1C$!D$(($8!100$55!(/!8$5/&80$5!(-1(!01#!D$!&5$+!(/!1C/'+!+'5$15$!8'56I!8$?18+2$55!/9!Q-1(!(-$!8'56Z@8/($0('C$!910(/85!18$!1(!(-$!(';$! d'#6!1#+![-$21#I!GHHOu![-$21#!$(!12RI!EFFN_R!!!! !

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Aithin FCT, it is by no means assumed that ‘disease […] flow[s] directly from income, education or occupational status into the body’. Neither do proponents of this approach +$#)! (-1(! @&D2'0! -$12(-! '#'('1('C$5! D15$+! /#! (-$! 8'56! 910(/8! 1@@8/10-! -1C$! D$$#! C$8)!5&00$559&2!'#!';@8/C'#?!/C$8122!@&D2'0!-$12(-R!>/Q$C$8Y!!

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=/#5$%&$#(2)I!7=<!&#+$82'#$5!(-$!5'?#'9'01#0$!/9!#/(!/#2)!9/0&5'#?!/#!8'56!910(/85!)%'$.%I$D&(!125/!/#!(-$!5)5($;^5_!(-1(!&#+$82'$!+'99$8$#0$5!'#!$K@/5&8$!(/!8'565R!"#!2'#$!Q'(-!(-'5I!d'#6! 1#+! [-$21#! -1C$! 8$0$#(2)! $K($#+$+! (-$'8! /8'?'#12! 9/8;&21('/#! /9! 7=<! D)! 10W6#/Q2$+?'#?!(-1(!02155!'5!D)!#/!;$1#5!(-$!/#2)!5/0'12!5(8&0(&8$!/@$81('#?!15!1!9&#+1;$#(12!01&5$R! 41(-$8I! 122! 5/0'12! @/5'('/#5! (-1t are ‘intimately linked to resources of money, knowledge, power, prestige, and beneficial social connections over time’, such as 5$KZ?$#W+$8I!$(-#'0'()!/8!5$K&12!/8'$#(1('/#I! 5-/&2+!D$!0/#5'+$8$+!@8/D1D2$! 9&#+1;$#(12!01&5$5!^[-$21#!1#+!d'#6I!EFGPY!GGP_R!!

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"#! 910(I!5/0'/Weconomic indicators such as those outlined above provide only ‘nominal classifications of a population according to a dimension of stratification’ ^.|8$#5$#I!EFFFY!GOEX_R!\5!5&0-I!(-$)!#$'(-$8!@8/@/5$!-/Q!#/8!Q-)!(-$!D15'5!/#!Q-'0-!(-$5$!02155'9'01('/#5!8$5(!0/;$!'#(/!D$'#?!^'D'+R_R!78/;!(-'5!9/22/Q5!1#!'#$C'(1D2$!%&$5('/#!–!#1;$2)Y!A-1(!'5!02155i!!

A'(-/&(!1!+/&D(I!(-$!0/#0$@(!/9!02155!-15!D$$#!5&D`$0(!(/!C15(!(-$/8$('012!15!Q$22!15!$;@'8'012!'#%&'8)I!#/(!2$15(!Q'(-'#!5/0'/2/?)R!U$C$8(-$2$55I!@/@&218!15!Q$22!15!101+$;'0!&51?$5!8$;1'#!';D&$+!Q'(-!1;D'?&'('$5!^,2'#!A8'?-(I!EFFOD_R!"#!(-$!@8$5$#(!(-$5'5I!02155!'5!&#+$85(//+! '#! 2'#$!Q'(-! (-$! ^#$/W_A$D$8'1#!1@@8/10-R!>$#0$I! '(! '5!155&;$+!(-1(! (-$!market in capitalist societies ‘distributes life chances according to the resources! f$R?R!$+&01('/#I!56'22!/8!@8/@$8()h! !that individuals bring to it’ ^J8$$#I!EFFOY!PE_R!"#!(&8#I!2'9$!chances can be understood as individuals’ chances of achieving, or gaining access to, C18'/&5!C12&$+!/&(0/;$5I!5&0-!15!?//+!-$12(-!/8!$;@2/);$#(!@8/5@$0(5! ^J8$$#I!EFFOu!A$D$8I!GHLV!fGHEEhY!PFE_R!J)!'+$#('9)'#?!(-$!;186$(!15!1!+$($8;'#1#(!/9!2'9$!0-1#0$5I!(-$!A$D$8'1#I! 2'6$! (-$! *18K'5(I! 02155! 1#12)5'5! +'99$85! ;186$+2)! 98/;! ;$8$2)! ?81+1('/#12!1@@8/10-$5R!<-$!+'99$8$#0$!2'$5!'#!(-$!910(!(-1(!02155!'5!#/(!+$9'#$+!5/2$2)!/#!(-$!D15'5!/9!$;@'8'0122)!/D5$8C$+!+'5@18'('$5!'#I!$R?RI!'#0/;$!^5$$!.|8$#5$#!1D/C$_R!41(-$8I!(-$!1#12)5'5!/9! 02155! D$?'#5!Q'(-! 1#! '+$#('9'01('/#! /9! (-$! 5/0'12! /8+$8! ^/8! 8$21('/#5_! (-1(! +$($8;'#$!individuals’ access to economic assets ^J8$$#I!EFFOu!,2'#!A8'?-(I!EFFO1_R!!

"#!2'#$!Q'(-!(-'5I! (-$!#$/WA$D$8'1#!02155!1#12)5'5I!Q-'0-!'5!&5&122)!155/0'1($+!Q'(-!(-$!M8'655/#–3/2+(-/8@$W[/8(/018$8/!^M3[_!50-$;$!^M8'65/#!1#+!3/2+(-/8@$I!GHHE1u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l$!+'99$8$#(!21D/&8!;186$(! @/5'('/#5R! \00/8+'#?2)I! $;@2/)$$5! 18$! +'99$8$#('1($+! as either having a ‘labour contract’, where the wageW9/8W$99/8(!$K0-1#?$!'5!C$8)!5@$0'9'0!1#+!(-$!Q/86$8!'5!02/5$2)!5&@$8C'5$+! ^()@'0122)! ;1#&12W! 1#+! #/#Wmanual workers), or a ‘service contract’ that '#C/2C$5! ;/8$! +'99&5$! $K0-1#?$5I! ;16'#?! ;/#'(/8'#?! ;/8$! +'99'0&2(! ^J8$$#I! EFFOu!3/2+(-/8@$I! EFFL_R! "#! (-$! @8$5$#(! 5(&+'$5I! "! &5$! (-$! .Q$+'5-! 5(1#+18+5! 9/8! ./0'/WM0/#/;'0!=2155'9'01('/#!^.M"_!(/!/@$81('/#12'l$!02155!^.(1('5('05!.Q$+$#I!GHVE_R!<-$!.M"!02/5$2)!8$5$;D2$5!(-$!M3[!50-$;$!and has thus been suggested to work as a viable ‘proxy’ ^J'-1?$#I!EFFLDu!<r-2'#I!EFFL_I!$C$#!(-/&?-!(-$!50-$;$5!@18(2)!+'99$8!'#!(-$'8!(-$/8$('012!D15'5R!*/8$!5@$0'9'0122), ‘skill’ is a key discriminant criterion!D$(Q$$#!02155$5!'#!(-$!.M"I!Q-$8$15!(-$!M3[!8$5(5!@8';18'2)!/#!(-$!+'5('#0('/#!D$(Q$$#!$;@2/);$#(!8$21('/#5!^5$$!1D/C$_!^d1;D$8(!1#+!J'-1?$#I!EFGNu!<r-2'#I!EFFL_R!>/Q$C$8I!15!18?&$+!D)!<-r2'#!^EFFLY!OOV_I!(-$5$!+'99$8$#0$5!have not been ‘very consequential for operationalizations’.!

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l'#?!(-1(!+'99$8$#0$5!'#!100$55!(/!8$5/&80$5I!1#+!(-$8$D)!2'9$!0-1#0$5I!+'+!#/(!18'5$!/&(!/9!#/(-'#?R! "#!8$21('/#! (/! (-'5I! '(! 5-/&2+! 1?1'#!D$!5(8$55$+! (-1(! '#!5(&+'$5! (18?$('#?!-$12(-! '#$%&'()I! +'99$8$#(! '#+'01(/85! /9! 02155Z.M.I! $R?RI! '#0/;$I! $+&01('/#! 1#+!/00&@1('/#12! 02155I! 18$! /9($#! &5$+! '#($80-1#?$1D2)R! "#5/;&0-! 15! (-$5$! ;$15&8$5! 18$!causally related and ‘reflect overlapping resources in terms of social standing’ ^</8551#+$8!1#+!M8'65/#I!EFGFY!NXO_I!(-'5!01#!D$!0/#5'+$8$+!`&5('9'$+R!U$C$8(-$2$55I!'(!'5!5('22!@21&5'D2$!(-1(! (-$)!0/&2+!D$! 2'#6$+! (/!-$12(-!C'1!@18(2)!+'99$8$#(!;$0-1#'5;5I!Q-'0-!;$1#5! (-1(!+'99$8$#(!'#+'01(/85!18$!/0015'/#122)!#$$+$+!^d1-$2;1!$(!12RI!EFFNu!</8551#+$8!1#+!M8'65/#I!EFGF_. For example, because parents’ class background has a strong impact on their children’s educational c-/'0$5I! $+&01('/#12! 1((1'#;$#(! #/(! /#2)! @8/C'+$5! '#9/8;1('/#!1D/&(I! $R?RI! 01@10'()! (/! ;1#1?$! $+&01('/#! 1#+! 10%&'8$+! 6#/Q2$+?$Z1D'2'('$5I! D&(! 125/!&@D8'#?'#?! 0/#+'('/#5! ^J'-1?$#I! EFFL1u! M8'65/#! 1#+!3/2+(-/8@$I! GHHE1u! M8'65/#! 1#+!q/#55/#I!GHHXu!>122$8]+!1#+!3&5(1955/#I!EFGGu!U/8+21#+$8I!EFGO_R!M+&01('/#!'5!9&8(-$8!1!strong predictor of individuals’ future labour market positions, which, in turn, affect their $0/#/;'0!@8/5@$0(5I!(-$'8!$K@/5&8$!(/!C18'/&5!Q/86'#?!0/#+'('/#5!15!Q$22!15!-/Q!(-$)I!@/($#('122)I! 10(! '#! 100/8+1#0$! Q'(-! 02155W5@$0'9'0! C12&$5! 1#+! D$2'$95! ^J'-1?$#I! EFFFu!J'-1?$#! 1#+!>122$8]+I! EFFF_R!\22! /9! (-$5$! 15@$0(5! 01#I! 15! +'50&55$+!@8$C'/&52)! '#! (-'5!0-1@($8I!D$!2'#6$+!(/!-$12(-!1#+!;/8(12'()I!12D$'(!'#!52'?-(2)!+'99$8$#(!Q1)5R!!

,#!(-$!0/#0$@(5!/9!5$KZ?$#+$8!![8$C'/&5! 8$5$180-! /#! -$12(-! '#$%&'('$5! -15! 8$C$12$+! 1! #/($Q/8(-)! @181+/KY! \2(-/&?-!Q/;$#!($#+!(/!/&(2'C$!;$#!'#!+$C$2/@$+!#1('/#5I!(-$!9/8;$8!?8/&@!0/#('#&/&52)!8$@/8(5!-'?-$8!81($5!/9!;/8D'+'()!108/55!1!Q'+$!81#?$!/9!'#+'01(/85!5&0-!15!5$29W155$55$+!-$12(-!/8!2';'('#?!2/#?W($8;!'22#$55!^5$$I!$R?RI!\2D$8(5!$(!12RI!EFGNu!J1;D81!$(!12RI!EFFH_R!\00/8+'#?2)I!5$KZ?$#+$8!'5!0&88$#(2)!C'$Q$+!15!1!0$#(812!+$($8;'#1#(!/9!-$12(-! ^*18;/(!$(!12RI!EFFVu!A/82+!>$12(-!,8?1#'l1('/#I!EFGNu!A/82+!>$12(-!,8?1#'l1('/#I!EFGX_I!1#+!+'99$8$#0$5!'#!$+&01('/#12! 1#+! /00&@1('/#12! /@@/8(&#'('$5! 18$! 0/#5'+$8$+! /#$! /9! (-$! ;1`/8! +8'C$85!&#+$82)'#?!(-$5$!+'99$8$#0$5!^5$$I!$R?RI!A/82+!>$12(-!,8?1#'l1('/#I!EFGX_R!A'(-!(-1(!51'+I!1!+$9'#'('/#!/9!0/#0$@(5!'5!#$$+$+!D$9/8$!?/'#?!/#!(/!+'50&55!-/Q!02155!1#+!5$KZ?$#+$8!'#($85$0(!(/!01&5$!+'5@18'('$5!'#!-$12(-!/&(0/;$5R!

\!0/;;/#!+'C'+$!'#!(-$!5/0'/2/?'012I!15!Q$22!15!(-$!$@'+$;'/2/?'012I!2'($81(&8$!'5!(-$!+'5('#0('/#!;1+$!D$(Q$$#! .%[! ^8$9$88'#?! (/! (-$! 155'?#;$#(!/9! 1#! '#+'C'+&12! 15!;12$!/8!9$;12$!D15$+!/#! (-$!@/55$55'/#!/9!;12$Z9$;12$!?$#'(12'1_!1#+!?$#+$8! ^8$9$88'#?! (/! ‘(-$!D$2'$95I!C12&$5!1#+!$K@$0(1('/#5!1((10-$+!(/!5$K!01($?/8'$5I!1#+! (-$!5/0'12! 8$21('/#5!1#+!/8+$8$+!@810('0$5!Q-'0-!(-$)!2$?'(';1($’_!^U$QI!EFFOY!XNI!5$$!125/!A$5(!p!o';;$8;1#I!GHVL_R!"#!2'#$!Q'(-!(-'5I!'(! '5!155&;$+!-$8$!(-1(!5$K!'5!/#(/2/?'0122)!@8'/8!(/!?$#+$8I!D&(!

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125/! (-1(!#$'(-$8!01($?/8)! '5! 8$+&0'D2$! (/I! #/8!$#('8$2)!+$($8;'#$+!D)I! (-$!/(-$8! ! ^U$QI!EFFO_R!41(-$8I!(-$)!18$!'#(8'#5'0122)!2'#6$+I!Q-'0-!;$1#5!(-1(!(-$!+'5('#0('/#!D$(Q$$#!(-$;!'5!9/8$;/5(!;1+$!9/8!1#12)('012!@&8@/5$5R!In line with this, I use the term ‘sex’ as I refer (/!0/#($K(5Z$;@'8'012!'#C$5('?1('/#5!Q-$8$!'#+'C'+&125!-1C$!D$$#!02155'9'$+!15!$'(-$8!;12$!/8! 9$;12$! 5/2$2)! D15$+! /#! 0$8(1'#! D'/2/?'012! 9$1(&8$5R! "#! 0/#(815(I! "! &5$! ?$#+$8! Q-$#!8$9$88'#?!(/!(-$!$K@$0(1('/#5I!#/8;5I!8$21('/#5!1#+!'#$%&'('$5!9/8!Q-'0-!5$KI!1#+!122$?$+!5$K&12!+'99$8$#0$I!5$8C$5!15!1!‘D15'5’!/8!8$9$8$#(R!"#!(-$!5&D5$%&$#(!5$0('/#I!"!@8/C'+$!5/;$!$K1;@2$5!/9!Q1)5!'#!Q-'0-!02155!1#+!?$#+$8!'#$%&'('$5!'#($85$0(!'#!8$21('/#!(/!-$12(-!1#+!;/8(12'()R!

"#($85$0('#?!+8'C$85!/9!'#$%&'()!!d18?$W5012$! +'99$8$#0$5! -1C$! $K'5($+! D$(Q$$#! ;$#! 1#+! Q/;$#! '#! ($8;5! /9! 100$55! (/!$+&01('/#!(-8/&?-/&(!-'5(/8)R!"#!.Q$+$#I!9/8!'#5(1#0$I!;$#!Q$8$!/C$88$@8$5$#($+!'#!@/5(W5$0/#+18)!$+&01('/#!15!21($!15!&#('2!(-$!;'+WGHHF5! .(1('5('05!.Q$+$#I!EFFV_R![8/C'+$+!(-1(!$+&01('/#! '5! 0&88$#(2)! 8$0/?#'l$+! 15! 1! 6$)! +$($8;'#1#(! /9! -$12(-I! (-$5$! +'5@18'('$5! 18$!08&0'12!(/!&#+$85(1#+'#?!-/Q!5$K!+'99$8$#0$5!'#!-$12(-!18'5$I!@18('0&2182)!'#!/2+$8!0/-/8(5!^A/82+! >$12(-! ,8?1#'l1('/#I! EFGX_. Likewise, although women’s labour market @18('0'@1('/#! '#08$15$+! 5&D5(1#('122)! '#! .Q$+$#! 1#+! $25$Q-$8$!+&8'#?! (-$! EF(-! 0$#(&8)!^.(1('5('05!.Q$+$#I!EFGG_I!+'99$8$#0$5!@$85'5(!'#!8$21('/#!(/!(';$!5@$#(!'#!@1'+!C$85&5!&#@1'+!Q/86!^.(1('5('05!.Q$+$#I!GHHEu!.(1('5('05!.Q$+$#I!EFGE_R!7/8!'#5(1#0$I!'#!GHLF!–!Q-$#!(-$!;1`/8'()!/9!@18('0'@1#(5!'#!(-$!@8$5$#(!5(&+)!51;@2$!Q$8$!'#!(-$'8!9/8('$5!–!(-$!$;@2/);$#(!81($5!1;/#?!.Q$+'5-!;$#! 1#+!Q/;$#! '#! (-'5!1?$!?8/&@!Q$8$!HXRX!1#+!XHRO!@$8!0$#(I!8$5@$0('C$2)! ^.(1('5('05! .Q$+$#I! GHLP_R! .('22! (/+1)I! 8$+&0$+! 21D/&8! 9/80$! @18('0'@1('/#!1;/#?!Q/;$#I!+$8'C'#?!98/;!#/8;5!@8$508'D'#?!(-1(!Q/;$#!(16$!(-$!;1'#!8$5@/#5'D'2'()!9/8! 0-'2+018$! 1#+! +/;$5('0! 0-/8$5I! -15! 1! 5(8/#?! ';@10(! /#! (-$'8! 100$55! (/! $0/#/;'0!8$5/&80$5I!`/D!5$0&8'()I!9&(&8$!@$#5'/#5!15!Q$22!15!@/55'D'2'('$5!/9!8/2$!$#-1#0$;$#(!^$R?RI!$#-1#0$+! 5/0'12! '#($?81('/#I! @8$5('?$! 1#+! 8$0/?#'('/#_I! 1#+! (-$8$D)! /#! (-$'8! -$12(-!@8/5@$0(5! ^5$$I! $R?RI!J21&! 1#+!g1-#I! EFGLu!:$$8$! 1#+!:/55I! EFFXu!*/$#! $(! 12RI! GHHOu!4/l18'/!$(!12RI!EFFNu!A/82+!>$12(-!,8?1#'l1('/#I!EFGX_R!!

J)! (-$!51;$!(/6$#I!Q/;$#!Q-/!Q/86!9&22W(';$!18$! 2'6$2)! (/!$K@$8'$#0$!1!+/&D2$!D&8+$#!/9!@8/9$55'/#12!1#+!+/;$5('0!$#?1?$;$#(5!(-1(!;&5(!D$!(16$#!'#(/!0/#5'+$81('/#!^5$$I!$R?I!38'99'#!$(!12RI!EFFE_I!$5@$0'122)!?'C$#!(-1(!(-$!0/;D'#1('/#!/9!-'?-!Q/862/1+5!'#!D/(-! @1'+! 1#+! &#@1'+! Q/86! -15! 8$@$1($+2)! D$$#! 9/&#+! (/! @8$+'0(! C18'/&5! 9/8;5! /9!@5)0-/2/?'012! 5(81'#!1#+! '22!-$12(-! ^\8D$8!$(!12RI!GHVOu!72/+$8&5!$(!12RI!EFFHu!>122I!GHHEu!g81#(l!$(!12RI!EFFO_R!7'#122)I!(-$!?$#+$8$+!+'C'5'/#!/9!^@1'+_!21D/&8!;&5(!D$!106#/Q2$+?$+R!"(!'5!Q$22W$5(1D2'5-$+!(-1(!(-$!/00&@1('/#5!'#!Q-'0-!Q/;$#!@8$+/;'#1($I!5&0-!15!-&;1#!5$8C'0$! @8/9$55'/#5I! @1)! 2$55! (-1#! (-/5$! Q'(-! 1! 2/Q$8! 5-18$! /9! Q/;$#I! 125/! Q-$#!0/#(8/22'#?!9/8!$+&01('/#!1#+!56'22!2$C$2!^M#?21#+I!EFGFu!d$C1#/#!$(!12RI!EFFH_R!\5!5(1($+!above, these differences ultimately confine women’s access to economic resources and (-&5!(-$'8!0/;@181('C$!0-1#0$5!/9!1((1'#'#?!?//+!-$12(-R!\++'('/#122)I!5(8$55/85!5&0-!15!$;/('/#12!+$;1#+5I!C'/2$#0$Z(-8$1(5!/9!C'/2$#0$I!1#+!(-$8$D)!199$0('C$!1#+!5(8$55W8$21($+!

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M#($8'#?!(-$!@/5(W‘nature C5R!nurture’ era!"#!1!8$0$#(2)!@&D2'5-$+!1#(-/2/?)!$#('(2$+!3"6-5,$!%*'".6-%/6%e$A'5-/9$J-/0$5/0$3"6-%#(!^EFGO_I!@5)0-'1(8'5(! 1#+! 0/W$+'(/8! *1(0-$8'! .R! g$5-1C1#! 8'?-(9&22)! #/($! (-1(! (-$! 9'$2+5! /9!neuroscience and social science ‘were often in different silos over much of the twentieth century’ (p. 29). In their introductory chapter, Keshavan, together with coW$+'(/85!4&55$2!gR! .0-&((! ^5/0'/2/?)_! 1#+! d188)! qR! .$'+;1#! ^@5)0-/2/?)_I! go on to state that ‘despite '#($8+'50'@2'#18)! 0/#5$#5&5! (-1(! humans are social animals’, their three respective disciplines have ‘taken markedly different stances toward the practical salience and the 01&512! +'8$0('/#! /9! (-$! D81'#W;'#+Wsociety link’ (p. 2_R! "#! 910(I! (-$)! 18?&$! (-1(! ;1#)!50-/2185!-1C$!8$?8$((1D2)!+$#'$+!(-$!$K'5($#0$!/9!(-'5!2'#6!1#+Z/8!8$`$0($+!(/!'#C$5('?1($!'(!12(/?$(-$8R!!

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A/86!$#C'8/#;$#(!$K@/5&8$5!In order to estimate participants’ exposure to different work environment exposures, we &5$+!(-$!C12'+1($+!q/D!MK@/5&8$!*1(8'K! qM*_!^q/-#5/#!$(!12RI!GHHFu!q/-#5/#!1#+!.($Q18(I!GHHP_R!<-$!+1(1!/#!Q-'0-!(-$!qM*!'5!D15$+!Q$8$!/8'?'#122)!51;@2$+!(-8/&?-!(-$!1##&12!.Q$+'5-! .&8C$)! /9! d'C'#?! =/#+'('/#5! '#! GHLL! 1#+! GHLHR! J)! &5'#?! 910(/8! 1#12)5$5! (/!0/;D'#$! 5$(5! /9! %&$5('/#5! @$8(1'#'#?! (/! Q/86! $#C'8/#;$#(I! q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q/-#5/#!$(!12RI!GHHF_I!Q-'0-I!'#!@810('0$I! ';@2'$5!(-1(!1!;1#!1#+!1!Q/;1#!-/2+'#?!(-$!51;$!/00&@1('/#!Q/&2+!D$!155'?#$+!+'99$8$#(!qM*!50/8$5R!J)!;1#&122)!0/;D'#'#?!(-$5$!qM*!scores with data on respondents’ life time principal occupation obtained from the >LFZ[[.A!$K1;'#1('/#5I!Q$!Q$8$!1D2$! (/!$5(';1($! (-$'8!$K@/5&8$! (/!$10-!/9! (-$! 9'C$!Q/86! $#C'8/#;$#(! 0-1810($8'5('05R! MC$#! (-/&?-! (-$! qM*! '5! 5(81('9'$+! 100/8+'#?! (/!+&81('/#!/9!(';$!5@$#(!'#!(-$!/00&@1('/#!15!Q$22!15!1?$!1(!(-$!(';$!(-$!/00&@1('/#!Q15!-$2+I!'(!125/!'#02&+$5!0/;D'#$+!50/8$5!9/8!$10-!/00&@1('/#!^122!+&81('/#I!122!1?$5_R!<-$5$!Q$8$!&5$+!'#!(-$!@8$5$#(!5(&+)!9/8!8$15/#5!8$21($+!(/!+1(1!1C1'21D'2'()R!

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u! g1-#! 1#+! \#(/#&00'I! GHVF_I! Q-'0-! &#+$82'#$5! (-$'8!;&2('+';$#5'/#12'()! D)! '+$#('9)'#?! (-8$$! 6$)! 15@$0(5! /9! '#+'C'+&12! #$(Q/865! ^5(8&0(&8$I!9&#0('/#!1#+!5&D`$0('C$!$C12&1('/#5!/9!%&12'()_I!5$C$#!/9!(-$5$!%&$5('/#5!Q$8$!'#02&+$+!'#!(-$! 1#12)5'5R!B#9/8(&#1($2)I! (-$! 1C1'21D2$! +1(1! +'+!#/(! '#02&+$!%&$5('/#5! 8$21($+! (/! (-$!9&#0('/#5!/9!5/0'12!#$(Q/865!^5@$0'9'0122)!5&@@/8(!1#+!8$0'@8/0'()_I!Q-'0-!;$1#5!(-1(!(-$!C18'1D2$5! &5$+! /#2)! 0/#0$8#! #$(Q/86! 5(8&0(&8$! 1#+Z/8! %&12'()R! J)! 0/;D'#'#?! (-$5$!C18'1D2$5! (-8/&?-! 910(/8! 1#12)5'5I! (Q/! 21($#(! C18'1D2$5! Q$8$! 8$(1'#$+! 1#+! &5$+! '#! (-$!5&00$$+'#?! 1#12)5$5Y! 6,".%$ ."6-5,$ /%#Y"'S.! 1#+! 0-.#5/#$ ."6-5,$ /%#Y"'S.R! <-$! 9/8;$8! Q15!constructed from the following two survey questions: (1): ‘Do you have an intimate person with whom you can talk about anything?’ and (2) ‘Do you have more than one intimate person?’!<-$!21(($8!Q15!0/#5(8&0($+!98/;!(-$!9/22/Q'#?! five questions: (1) ‘Do you and your neighbours visit each other to say hello?’, (2) ‘Do you stop and talk with your neighbours when you meet?’, (3) ‘Do you think you have enough contact with your

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neighbours?’, (4) ‘Do you think you have enough contact wit-!@$/@2$!/(-$8! (-1#!)/&8!children or neighbours?’, (5) ‘Do you receive visits from or visit people other than your children or neighbours?’. !

[5)0-/2/?'012!+'5(8$55!3$#$812! @5)0-/2/?'012! +'5(8$55!Q15! '#+'01($+!D)! 1! 21($#(! C18'1D2$! 0/#5(8&0($+! 98/;! (-$!0/C18'1#0$!D$(Q$$#! 5$C$#!;1#'9$5(! '($;5! ^122!;$15&8$+! 1(! D15$2'#$_2$<-$! 9'85(I!E'%&-"*.$0%)'%..-"/I$ '5!5$29W8$@/8($+!1#+!'#+'01($5!Q-$(-$8!/8!#/(!1#! '#+'C'+&12!-1+!5&99$8$+!98/;!+$@8$55'/#!@8'/8!(/!(-$!D15$2'#$!$K1;'#1('/#R!<-$!5$0/#+!'($;I!>5&%$%[)%'-%/6%0$"/%$"'$4"'%$)%'-"0C.D$ ":$ .#'%..$ -/$ ,-:%9$was constructed from the following survey question: ‘Have you $K@$8'$#0$+!1#)!@$8'/+!/9!5(8$55!^/#$!;/#(-!/8!2/#?$8_! '#! 8$21('/#!(/!0'80&;5(1#0$5!'#!$C$8)+1)! 2'9$I! 5&0-! 15!Q/86I! -$12(-! /8! 91;'2)! 5'(&1('/#i!J)! 5(8$55!Q$!;$1#! 9$$2'#?5!/9!irritability, tension, nervousness, fear, anxiety or sleep disturbances’.!<-$!(-'8+!1#+!9/&8(-!'#+'01(/8I! 35#-.:56#-"/$ Y-#8$ ."6-5,$ .-#*5#-"/! 1#+! 3%,:T%.#%%4I! Q15! /D(1'#$+! 98/;! 1! D1(($8)! /9!%&$5('/#5!'#!/#$!/9!(-$!D15$2'#$!%&$5('/##1'8$5!Q-$8$!@18('0'@1#(5!Q$8$!156$+!(/!81($!(-$'8!51('5910('/#!'#!8$21('/#!(/!+'99$8$#(!2'9$!+/;1'#5!/#!1!5$C$#Wpoint scale ranging from ‘very good, could not be better’ to ‘very bad’. The fifth and final indicator, O"/=.#5/0-/=!:%%,-/=.$":$,"/%,-/%..I!Qas based on the following question: ‘Do you feel lonely?’. The respondents 0/&2+!125/!5@$0'9)!9/8!-/Q!2/#?!(-$)!-1+!D$$#!9$$2'#?!2/#$2)R!

.(1('5('012!;$(-/+5!!<-$!$;@'8'012!5(&+'$5!&('2'l$+!1!81#?$!/9!+'99$8$#(!5(1('5('012!;$(-/+5!1#+!(-$!1#12)5$5!Q$8$!;1'#2)!0/#+&0($+!'#!.<\<\! C$85'/#5!GN!1#+!GO_R!4!1#+!*[2&5! C$85'/#!V_!Q$8$!125/!&5$+!9/8!5@$0'9'0!@&8@/5$5!'#!.(&+)!"!1#+!"cI!8$5@$0('C$2)R!J$2/QI!"!@8/C'+$!1!D8'$9!5&;;18)!/9!(-$!5@$0'9'0!($0-#'%&$5!&5$+!'#!$10-!@1@$8R!!

"#!'()*+,-,28*,---I!=/K!@8/@/8('/#12!-1l18+5!8$?8$55'/#!Q15!$;@2/)$+I!Q-'0-!01#!D$! ?8/&@$+!&#+$8! (-$! &;D8$221! ($8;! 5&8C'C12! 1#12)5'5R!<-$! 0/;;/#!+$#/;'#1(/8! 9/8!these modelling techniques is that they are focused on ‘whether!1#+!Q-$#!1#!$C$#(!(16$5!place’ ^3&/I!EFGFY!P_R!\#!1+C1#(1?$!/9!=/K!8$?8$55'/#!^1#+!5&8C'C12!1#12)5'5!'#!?$#$812_!0/;@18$+!(/!/8+'#18)!8$?8$55'/#!($0-#'%&$5!'5!(-1(!'(!100/;;/+1($5!8'?-(W0$#5/8$+!015$5I!Q-'0-!;$1#5!(-1(!'(!100/&#(5!9/8!(-$!910(!(-1(!'#+'C'+&125!Q-/!#$C$8!5&99$8!(-$!$C$#(!/9!'#($8$5(! 5('22! 0/#(8'D&($! 5&8C'C12! (';$! ^72)##I! EFGEu! 3&/I! EFGF_R! <-'5! Q15! 0/#5'+$8$+!1+C1#(1?$/&5! ?'C$#! (-$! 8$21('C$2)! 5;122! 51;@2$! 5'l$! 1#+! 9$Q!+$;$#('1! 015$5R!\5! '#! 122!5&8C'C12! 1#12)5'5I! (-$!+$@$#+$#(!C18'1D2$! '5! 5&8C'C12! (';$I! 1#+! '#! (-$!@8$5$#(! 5(&+'$5I! '(!;$15&8$+! )$185W1(W8'56! 9/8! +$;$#('1! 5(18('#?! 98/;! 1?$! XOR! =/#5$%&$#(2)I! 1#+! D$01&5$!+'99$8$#0$5! '#!1?$!/9!+'1?#/5'5!$K'5(!D$(Q$$#!0/-/8(5! '#! (-$! 9&22!D15$2'#$! 51;@2$I! (-$5$!5(&+'$5!/#2)!&('2'l$!+1(1!98/;!'#+'C'+&125!D/8#!'#!GHPF!^7'?&8$!E_R!<-$!C12&$5!/9!(-$!D$(1W0/$99'0'$#(5! 18$! $5(';1($+! (-8/&?-! [18('12! d'6$2'-//+! M5(';1('/#! ^\22'5/#I! EFGNu! J/KW.($99$#5;$'$8!1#+!q/#$5I!EFFN_I!Q-'0-!+$@$#+5!/#2)!/#!(-$!/8+$8I!#/(!(-$!$K10(!(';$I!'#!

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Q-'0-!$C$#(5!/00&85R!>1l18+!81('/5I!Q-'0-!'5!1!8$21('C$!;$15&8$!'#+'01('#?!(-$!+'99$8$#0$!'#!-1l18+!81($5!D$(Q$$#!^$R?R_!(Q/!?8/&@5I!1#+Z/8!@8$+'0($+!5&8C'C12!(';$5I!Q$8$!8$@/8($+R!!

"#!'()*+,--I!(-$!;1'#!/&(0/;$!C18'1D2$!Q15!+'0-/(/;/&5!^'#+'01('#?!Q-$(-$8!1#!'#+'C'+&12!-1+!D$$#!+'1?#/5$+!Q'(-!+$;$#('1!@8'/8!(/I!/8!+&8'#?I!)$18!EFGE_R!<-$!1#12)5$5!Q$8$!(-&5!D15$+!/#!+1(1!98/;!(-$!9&22!D15$2'#$!51;@2$!^7'?&8$!E_R!7&8(-$8I!D'#18)!2/?'5('0!8$?8$55'/#!Q15!&5$+I!Q-'0-!'5!1+C1#(1?$/&5!'#!(-$!5$#5$!(-1(!'(!+/$5!#/(!155&;$!1!2'#$18!8$21('/#5-'@!D$(Q$$#!(-$!/&(0/;$!C18'1D2$!1#+!(-$!@8$+'0(/85! ^d/#?!1#+!78$$5$I!EFFX_R!,++5!81('/5I!8$@8$5$#('#?!‘(-$!/++5!(-1(!1#!/&(0/;$!Q'22!/00&8!?'C$#!1!@18('0&218!$K@/5&8$I!compared to the odds of the outcome occurring in the absence of that exposure’ ^.l&;'215I!EFGFY!EEL_I!Q$8$!8$@/8($+R!!

"#!'()*+,---I!5$C$#!C18'1D2$5!Q$8$!0/;D'#$+!(-8/&?-!$K@2/81(/8)!910(/8!1#12)5'5!'#!/8+$8! (/! $#1D2$! 1! D$(($8! 0/#0$@(&12! &#+$85(1#+'#?! /9! 8$21('/#5-'@5! 1;/#?! @/($#('12!'#+'01(/85!/9!'#+'C'+&12!5/0'12!#$(Q/865R!"#!2'#$!Q'(-!(-'5I!(-$!8$(1'#$+!910(/85!5-/&2+!(-&5!be considered ‘unobservable latent variables that influence more than one measured C18'1D2$!'#!1!D1(($8)!1#+!18$!f(-&5h!@8$5&;$+!(/!100/&#(!9/8!(-$!0/88$21('/#5!^0/C18'1#0$5_!1;/#?!(-$!;$15&8$+!C18'1D2$5’!^71D8'?18!$(!12RI!GHHHY!ELO_R!

,'()*A49,-Z---!122!5$(!/&(!(/!$K@2/8$$4"0%'5#-"/I!'R$RI!Q-$(-$8!(-$!$99$0(!/9!GE7H$εN!0/&2+!D$!12($8$+!D)!$K($8#122)!';@/5$+!910(/85R!<-'5!Q15!+/#$!D)!'#02&+'#?!;&2('@2'01('C$!?$#$t$#C'8/#;$#(!'#($810('/#!($8;5!'#!(-$!;&2('C18'1($!;/+$25R!A-'2$!(-'5!($0-#'%&$!'5!1+C1#(1?$/&5!'#!(-$!5$#5$!(-1(!'(!$#1D2$5!&5!(/!$5(';1($!(-$!$K($#(!(/!Q-'0-!(-$!$99$0(!/9!GE7H$ εN! '5! +$@$#+$#(! /#! 5/;$! /(-$8! 910(/8I! '#02&+'#?! 01($?/8'012! D)! 01($?/8'012!'#($810('/#5!;16$5!'#($8@8$(1('/#!;/8$!0/;@2'01($+R!"#!@18(I!(-'5!+$@$#+5!/#!(-$!910(!(-1(!(-$8$!'5!#/!2/#?$8!1!5'#?2$!8$9$8$#0$!01($?/8)!/8!D15$!2$C$2!^15!'5!(-$!015$!Q-$#!1!8$?&218!+&;;)! C18'1D2$! '5! '#02&+$+_R! 7/8! $K1;@2$I! 1#+! 0/#5'+$8'#?! (-$! '#($810('/#! ($8;!.M.tGE7H$ εNI! 122! 0/;D'#1('/#5! '#02&+'#?! (-$! 8$9$8$#0$! 01($?/8)! 9/8! 1#)! /9! (-$5$!@8$+'0(/85$18$!(8$1($+!15!D15$!^.(1(1=/8@I!EFGP_R!7&8(-$8I!;&2('@2'01('C$!'#($810('/#!;/+$25!+'99$8!98/;!2'#$18W1++'('C$!8$?8$55'/#!;/+$25!D$01&5$!(-$!0/$99'0'$#(!/9!1#)!0/#5('(&('C$!($8;! �! 01##/(! D$! '#($8@8$($+! 15! 1#! &#0/#+'('/#12! ;18?'#12! $99$0(R! "#5($1+I! Q-$#! 1#!'#($810('/#!($8;!�to!'5!'#02&+$+I!(-$!D$(1!0/$99'0'$#(!/9!(-'5!($8;!'#+'01($5!/#2)!(-$!$99$0(!/9!1!/#$W&#'(!0-1#?$!'#!�!/#!j!Q-$#!(-$!0/#+'('/#'#?!C18'1D2$!^o_!'5!l$8/!^J81;D/8!$(!12RI!EFFX_R!<16$#!(/?$(-$8I!(-$!5@$0'9'0!9$1(&8$5!/9!(-$!'#($810('/#!;/+$25!+$508'D$+!1D/C$!';@2)! (-1(! '(! '5! #/(! @/55'D2$! (/! +81Q! 1#)! 5&D5(1#('12! 0/#02&5'/#5! D15$+! 5/2$2)! /#! (-$!$5(';1($5!98/;!(-$!(81+'('/#12!8$5&2(5!(1D2$R!<-&5I!'#![1@$8!"W"""I!@/5(!-/0!0/;@&(1('/#5!Q$8$!@$89/8;$+!/#!122!'#($810('/#!;/+$25!'#!/8+$8!(/!@8$+'0(!1#+!0/;@18$!(-$!$99$0(!/9!GE7H$εN!1(!+'99$8$#(!2$C$25!/9!(-$!;/+$81('#?!C18'1D2$!'#!%&$5('/#R!

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latent constructs are, in a sense, ‘error free’ ^5$$I! $R?RI! >122$8]+! 1#+! .$2+z#I! EFGP_R!*/8$/C$8I!(-$!8$5'+&125!01#!D$!'#0/8@/81($+!'#(/!(-$!;/+$2R!3'C$#!(-$!5@$0'9'0!9$1(&8$5!/9! (-$! /D5$8C$+! '#+'01(/8! C18'1D2$5I! (-$! Q$'?-($+! 2$15(! 5%&18$5! ;$1#5! 1#+! C18'1#0$!1+`&5($+! ^Ad.*c_!$5(';1(/8!Q15!&5$+! '#!122!1#12)5$5! ^J$1&+&0$2!1#+!>$8lD$8?I!EFFXu!J8/Q#I! EFGO_R! J$01&5$! (-$!Ad.*c! $5(';1(/8! '5! 0/;@&(1('/#122)! 2';'($+! '#! -1#+2'#?!;'55'#?#$55! (-1(!-15!#/(!/00&88$+!0/;@2$($2)!1(! 81#+/;I!;'55'#?!C12&$5!Q$8$! ';@&($+!&5'#?! J1)$5'1#! 1#12)5'5! ^\5@18/&-/C! 1#+! *&(-z#I! EFGF1u! \5@18/&-/C! 1#+! *&(-z#I!EFGFD_!

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

.1;@2$!5'l$!:$5@'($!(-$!8'0-#$55!/9!(-$!+1(1!0/22$0($+I!(-$!51;@2$!5'l$I!1#+!@18('0&2182)!(-$!#&;D$8!/9!+$;$#('1!015$5I!'5!8$21('C$2)!5;122!'#!122!9/&8!5(&+'$5!^#/(!2$15(!1;/#?!;12$5_R!J$01&5$!/9!(-$!5;122!#&;D$8!/9!+$;$#('1!015$5!1#+Z/8!2106!/9!'#9/8;1('/#I!Q$!+'+!#/(!+'5('#?&'5-!D$(Q$$#!+$;$#('1!5&D()@$5!'#!1#)!/9!(-$!9/&8!5(&+'$5R!<-'5!'5!1!5'?#'9'01#(!2';'(1('/#I!15!GE7H!ɛN! '5! 9/8$;/5(! 0/#5'+$8$+! 1! 8'56! 910(/8! 9/8!\:R!7/8! /(-$8! +$;$#('1! 5&D()@$5I!155/0'1('/#5!18$!2$55!Q$22W$5(1D2'5-$+I!$C$#!(-/&?-!5/;$!5(&+'$5!-1C$!5&??$5($+!(-1(!(-$!ɛN!122$2$!0/&2+!125/!D$!155/0'1($+!Q'(-I!$R?RI!c1:!^d'&!$(!12R!EFGEu!4/-#I!EFGN_!1#+!:dJ!^g$/?-!$(!12RI!EFGX_R!\:!'5I!-/Q$C$8I!(-$!;/5(!0/;;/#!5&D()@$I!1#+!8$0$#(!9'#+'#?5!-1C$!+$;/#5(81($+! (-1(! ;1#)! @$/@2$! Q'(-! +$;$#('1! -1C$! D81'#! 1D#/8;12'('$5! (-1(! 01#! D$!1((8'D&($+! (/!;/8$! (-1#!/#$!01&5$!–! ';@2)'#?! (-1(!;'K$+!@1(-/2/?'$5!;'?-(! '#! 910(!D$!more common than ‘pure’ ones ^\(($;5!1#+!q$22'#?$8I!EFGPu!q1;$5!$(!12RI!EFGXu!q$22'#?$8I!EFFLu! g1@15'! $(! 12RI! EFGLu! U$&8/@1(-/2/?)! 38/&@! /9! (-$! *$+'012! 4$5$180-! =/&#0'2!=/?#'('C$! 7&#0('/#! 1#+! \?$'#?! .(&+)! ^*4=! =7\._I! EFFGu! .0-#$'+$8! $(! 12RI! EFFLu!.0-#$'+$8!$(!12RI!EFFH_R!U$C$8(-$2$55I!(-$!2';'(1('/#5!8$21($+!(/!51;@2$!5'l$!';@2)!(-1(!(-$!8$5&2(5!;&5(!D$!'#($8@8$($+!Q'(-!01&('/#!1#+I!1++'('/#122)I!&#+$82'#$!(-$!0/#('#&'#?!#$$+!9/8!218?$!2/#?'(&+'#12!5(&+'$5!Q'(-!2/#?^$8_!9/22/QW&@5R!

4$C$85$!01&512'()!4$C$85$!01&512'()!'5!1!5'?#'9'01#(!'55&$!Q-$#!5(&+)'#?!910(/85!(-1(!0/&2+!D$!D/(-!8'56!910(/85!9/8I!1#+Z/8!@8$W+'1?#/5('0!5'?#5!/9I!+$;$#('1I!5&0-!15!5/0'12!'5/21('/#!/8!+$@8$55'/#R!<-'5!'55&$!'5!@8';18'2)!8$2$C1#(!(/!.(&+)!"""!1#+!"cR!"#!D/(-!015$5I!Q$!1(($;@($+!(/!8$+&0$!(-$!@/55'D'2'()!/9! 5&0-!D'15!D)!$K02&+'#?! '#+'C'+&125!Q-/!Q$8$!+'1?#/5$+!Q'(-!+$;$#('1!1(!

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! PP!

D15$2'#$! /8! @8'/8! (/! (-$! D15$2'#$! $K1;'#1('/#R! \++'('/#122)I! '#! .(&+)! "cI! Q$! $K02&+$+!'#+'C'+&125!Q-/!-1+!D$$#!+'1?#/5$+!+&8'#?!(-$!9'85(!)$18!19($8!D15$2'#$!1#+Z/8!/8!-1+!1!D15$2'#$!*'#'!*$#(12!.(1($!MK1;'#1('/#!^**.M_!50/8$!/9!2$55!(-1#!EN!^5$$I!$R?RI!g18@!$(!12RI!EFFXu!.($@-1#!$(!12RI!EFGPu!A1#?!$(!12RI!EFFE_R!\#/(-$8!5(8$#?(-!'#!(-$!21(($8!5(&+)!'5!(-1(! (-$! '55&$! /9! 8$C$85$! 01&512'()! Q15! 1++8$55$+! ;/8$! $K@2'0'(2)! (-8/&?-! 5$%&$#('12!$K02&5'/#!/9!+$;$#('1!015$5!1#+!8$@$('('/#!/9!(-$!1#12)5$5!1(!+'99$8$#(!(';$!@/'#(5R!!

.$2$0('/#!D'15!Selection bias occurs when ‘individuals with certain characteristics are underrepresented in the sample’ studied ^g$29C$I!EFGLY!V__,3$#$8122)!5@$16'#?I!5&0-!&#+$88$@8$5$#(1('/#I!8$5&2('#?!$'(-$8!98/;!51;@2$!$K02&5'/#!/8!#/#8$5@/#5$I!'5!6#/Q#!(/!D$!0/88$21($+!Q'(-!D/(-!1?$I!-$12(-I!9&#0('/#12!1D'2'()I!.M.!1#+!5$K!^5$$I!$R?RI!>18+)!$(!12RI!EFFHu!g$29C$!$(!12RI!EFGP_R! .(&+)'#?!-$12(-!/&(0/;$5I! 5@$0'9'0122)!Q'(-! 1! 9/0&5!/#!-$12(-! '#$%&'()I! '#! /2+$8!@/@&21('/#5!(-&5!$#(1'25!1!81#?$!/9!5@$0'9'0!0-122$#?$5R!\5!+$508'D$+!'#!;/8$!+$(1'2!1D/C$I!1!5&D5(1#('12!'55&$!'#!5(&+'$5!(18?$('#?!-$12(-!'#$%&'()!'#!/2+$8!0/-/8(5!'5!/"/T'5/0"4$4"'#5,-#($.%,%6#-"/! ^5/;$(';$5! 8$9$88$+! (/! 15! 6"8"'#$ -/&%'.-"/_! ^:&@8$I! EFFLu!:&@8$I! EFFVu!U/);$8I!EFFGu! .-&$)! 1#+!A'225/#I! EFFVu!A'225/#! $(! 12RI! EFFL_R! "(! /00&85! 15! 1! 8$5&2(! /9! -'?-$8!;/8(12'()!81($5!'#!)/&#?!1?$5!1;/#?!(-$!2$55!1992&$#(!1#+Z/8!(-/5$!Q'(-!@//8$8!-$12(-R!=/#5$%&$#(2)I!'#+'C'+&125!Q-/!5&8C'C$!&#('2!/2+!1?$!18$!?$#$8122)!-$12(-'$8!(-1#!(-/5$!Q-/!+/!#/(I!Q-'0-!;1)!8$5&2(!'#!1!5)5($;1('0!&#+$8$5(';1('/#!/9!(-$!155/0'1('/#!D$(Q$$#!.M.!1#+! -$12(-! 15! (-$! 0/-/8(! 1?$5! ^:&@8$I! EFFLu!:&@8$I! EFFVu!g$29C$I! EFGL_R! <-$8$9/8$I!2/#?'(&+'#12!5(&+)!+$5'?#5!(-1(!'#0/8@/81($!(';$I!5&0-!15!(-/5$!'#![1@$8!"!1#+!"""I!18$!/9($#!@8$9$81D2$!(/!08/55W5$0('/#12!/#$5R!7'#122)I!1#+!'#!8$21('/#!(/!(-$!'55&$5!/9!51;@2$!$K02&5'/#!1#+!#/#W8$5@/#5$I!'(!'5!Q/8(-!&#+$82'#'#?!(-1(!/#$!1+C1#(1?$!/9!>LFZ[[.A!5(&+'$5!'5!(-$!'#02&5'/#!/9!'#+'C'+&125!2'C'#?!'#!'#5('(&('/#5!15!Q$22!15!(-$!&5$!/9!@8/K)!'#($8C'$Q5! 8$9$88$+!to above as ‘close informant interviews’) ^5$$I!$R?RI!g$29C$I!EFGL_R!

*'502155'9'01('/#!"#!8$21('/#!(/!(-$!@8$5$#(!5(&+'$5I!5/;$!5@$0'9'0!'55&$5!8$21('#?!(/!;'502155'9'01('/#!;&5(!D$! 1++8$55$+R! *'502155'9'01('/#! 8$9$85! (/! ‘when sensitivity and/or specificity of the @8/0$+&8$! (/! +$($0(! $K@/5&8$! 1#+Z/8! $99$ct is not perfect’ ^:$2?1+/W4/+8'?&$l! 1#+!d2/801I!EFFNY!XPV_R!

3"6-"T%6"/"4-6$.#5#*.$"#9/8;1('/#!/#!@8'#0'@12!2'9$(';$!/00&@1('/#I!15!Q$22!15!2$C$2!/9!$+&01('/#12!1((1'#;$#(I!Q15!5$29W8$@/8($+!1#+!0/22$0($+!8$(8/5@$0('C$2)I!Q-'0-!'5!1!@/55'D2$!5/&80$!/9!8$0122!D'15!^d15(!$(!12RI!EFFG_R!"#!8$21('/#!(/!/00&@1('/#12!02155I!1#/(-$8!@/($#('12!'55&$!'5! (-$!&5$!/9!(-$!.Q$+'5-!5(1#+18+5!9/8!./0'/WM0/#/;'0!=2155'9'01('/#!^.M"_R!<-$5$!02155'9'01('/#5!18$!currently considered somewhat ‘outdated’!D$01&5$!/9!0-1#?$5!'#!(-$!$+&01('/#12!5)5($;!15!Q$22!15!'#!(-$!1;/&#(!/9!50-//2'#?!8$%&'8$+!9/8!+'99$8$#(!/00&@1('/#5!(-1(!-1C$!(16$#!@210$!+&8'#?!8$0$#(!+$01+$5R!<-'5!Q15I!-/Q$C$8I!0/#5'+$8$+!8$21('C$2)!&#W@8/D2$;1('0I!1#+!

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$C$#!1!@/55'D2$!1+C1#(1?$I!0/#5'+$8'#?!Q-$#!(-$!;1`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l$! 1#+I! D)!$K($#5'/#I!?8/&@!5'l$R!A-'2$! '(!+/$5!0/#5('(&($!1!@/($#('12! (-8$1(! (/! (-$!C12'+'()!/9! (-'5!;$15&8$I!'(!5-/&2+!D$!&#+$82'#$+!(-1(!(-$!#&;D$8!/9!5$29W$;@2/)$+!'#+'C'+&125!Q15!5;122!^ERX}I!!!a!EE_!1#+!(-$!#&;D$8!/9!918;$85!$C$#!5;122$8!^FRG}I!!!a!G_R!\#/(-$8!@21&5'D2$!'55&$!8$21($+!(/!(-$!/@$81('/#12'l1('/#!/9!.M.!0/#0$8#5!(-$!&5$!/9!'#+'C'+&12I!81(-$8!(-1#!-/&5$-/2+I! ;$15&8$5R! J$01&5$! ;$#I! @18('0&2182)! '#! @8$C'/&5! ?$#$81('/#5I! Q$8$! &5&122)!;/8$! 5(8/#?2)! 1((10-$+! (/! (-$! 21D/&8! ;186$(! (-1#! Q/;$#! Q$8$I! '(! '5! @/55'D2$! (-1(!-/&5$-/2+!02155!Q/&2+!-1C$!D$$#!1!;/8$!$99'0'$#(I!/8!1(!2$15(!0/;@2$;$#(18)I!;$15&8$!(/!155$5!.M.!'#!(-$!@8$5$#(!5(&+'$5!^5$$I!$R?RI!M8'65/#I!GHVNu!M8'65/#!1#+!3/2+(-/8@$I!GHHEDu!>$22$C'6I!GHVV_R!B#9/8(&#1($2)I!-/Q$C$8I!8$5@/#+$#(5!'#!(-$!>LFZ[[.A!5(&+'$5!Q$8$!#/(!156$+!1D/&(!(-$!/00&@1('/#12!-'5(/8)!/9!(-$'8!5@/&5$R!!

F"'S$%/&-'"/4%/#$%[)".*'%.$<he job exposure matrix that was used to assess individuals’ exposure to different work environment factors (Study II) offers relatively ‘crude’ measurements in the sense that it /#2)!@8/C'+$5!1??8$?1($!$5(';1($5!^/00&@1('/#12!;$1#5_R!<-'5!'5!1!@/($#('12!Q$16#$55I!15!subjective experiences of one’s work environment might, depending on the exposure in %&$5('/#I!D$!$%&122)!/8!$C$#!;/8$!';@/8(1#(!(/!-$12(-!(-1#!10(&12!Q/86'#?!0/#+'('/#5R!,#!(-$!/(-$8!-1#+I!(-$!&5$!/9!/00&@1('/#12!1C$81?$5!'5!@/($#('122)!1+C1#(1?$/&5!'#!(-$!5$#5$!(-1(!$5(';1($5!18$!#/(!199$0($+!D)!'#+'C'+&12!+'99$8$#0$5!'#I!$R?RI!@$85/#12'()!1#+!?$#$812!Q$22WD$'#?R!*/8$/C$8I!1#+!$C$#!(-/&?-!(-$!qM*!'5!5(81('9'$+!100/8+'#?!(/!2$#?(-!/9!(';$!5@$#(!'#!(-$!/00&@1('/#!15!Q$22!15!1?$!1(!(-$!(';$!(-$!/00&@1('/#!Q15!-$2+I!Q$!&5$+!(-$!0/;D'#$+!50/8$!9/8!8$15/#5!8$21($+!(/!+1(1!1C1'21D'2'()!^5$$!1D/C$_R!"#!8$21('/#!(/!$K@/5&8$!+&81('/#I!'(!5-/&2+!D$!#/($+!(-1(!$C$#!(-/&?-!Q/;$#!Q-/!5(1($+!(-1(!(-$)!-1+!@8';18'2)!D$$#!$#?1?$+!'#!+/;$5('0!Q/86!+&8'#?!Q/86'#?!1?$5!Q$8$!$K02&+$+!98/;!(-$!1#12)5$5I!Q/;$#!Q-/!+'+!Q/86!;1)!5('22!-1C$!5@$#(!2/#?$8!@$8'/+5!(-1#!;$#!/&(5'+$!(-$!21D/&8!;186$(R!!

3"6-5,$/%#Y"'S.$5/0$).(68","=-65,$0-.#'%..$<-$!/@$81('/#12'l1('/#!/9!;$15&8$5!1#+!(-$!%&12'()!/9!(-$!910(/8!'#+'01(/85!&5$+!'#!.(&+)!"""!1#+!"c!;&5(!125/!D$!106#/Q2$+?$+R!A'(-!8$?18+!(/!(-$!9/8;$8I!1!@/($#('12!5/&80$!/9!#/#WC12'+'()!'5!(-$!+'99'0&2()!/9!+$2'#$1('#?!the extent to which individuals’ assessment of (-$'8! 5/0'12! 8$21('/#5!1(!/#$!5@$0'9'0! (';$!@/'#(!provides a ‘general’ description of their 5/0'12! #$(Q/865! (-8/&?-/&(! 2'9$I! @18('0&2182)! ?'C$#! (-$! 0-1#?$5! '#! 5/0'12! 8$21('/#5! (-1(!1?$'#?! ;'?-(! $#(1'2R! J)! (-$! 51;$! (/6$#I! '(! 5-/&2+! D$! 5(8$55$+! (-1(! 122! '#+'01(/85! /9!

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! PO!

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<-$! 9'#+'#?5! /D(1'#$+! (-8/&?-! .(&+)! "! '#+'01($! (-1(! -'?-! .M.! ;/+$81($5I! /8!‘buffers’, the effect of GE7H! ε4 by postponing onset among male, but not female, 0188'$85R!J)!$K($#5'/#I!(-'5!5&??$5(5!(-1(!(-$!+'51+C1#(1?$5!100&;&21($+!D)!;$#!Q'(-!2/Q!SES could potentially ‘trigger’ the genetic predisposition to dementia or, converse2)I!(-1(!(-$!1+C1#(1?$5!100/;@1#)'#?!-'?-!.M.!18$!2'6$2)!(/!0/;@$#51($!9/8!(-$!'#08$15$+!?$#$('0!8'56!';@2'$+!D)$GE7H!ε4. A similar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dis)advantage that ‘put people at risk of risks’ ^d'#6!1#+![-$21#I!GHHOu![-$21#!$(!12RI!EFFN_R!<-'5!(-$;$!Q'22!D$!9&8(-$8!$21D/81($+!'#!(-$!5&00$$+'#?!5$0('/#I!Q-$8$!"!18?&$!(-1(!02155!1#+!5$KZ?$#+$8!5-/&2+!D$!0/#5'+$8$+!9&#+1;$#(12!01&5$5!/9!+$;$#('1R!!

"#($85$0('#?!5)5($;5!/9!^+'5_1+C1#(1?$!'#!+$;$#('1!8'56!!\!0$#(812!@8$;'5$!?&'+'#?!122!(-$!Q/86!8$5&2('#?!'#!(-'5!(-$5'5!-15!D$$#!(-1(!(-$!8'56!910(/85!9/8!+$;$#('1I!/8!1#)!/(-$8!+'5$15$!9/8!(-1(!;1(($8I!;&5(!D$!5(&+'$+!'#!8$21('/#!(/!(-$!5/0'12!5(8&0(&8$5!(-1(!&#+$82'$!+'99$8$#0$5!'#!8'56!$K@/5&8$R!"#!2'#$!Q'(-!(-'5I!"!-1C$!8$@$1($+2)!5(8$55$+! (-1(! 122! 5/0'12! @/5'('/#5! (-1(! 18$! ‘'#(';1($2)! 2'#6$+! (/! 8$5/&80$5! /9! ;/#$)I!6#/Q2$+?$I!@/Q$8I!@8$5('?$I!1#+!D$#$9'0'12!5/0'12!0onnections over time’, such as class or 5$KZ?$#+$8I! 5-/&2+!D$!0/#5'+$8$+! :*/054%/#5,$ 65*.%.!/9!+'5$15$! ^d'#6!1#+![-$21#I!GHHOu!

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`/D! 5$0&8'()! 1#+! (-$'8! 100$55! (/! $0/#/;'0! 8$5/&80$5I! 15! Q$22! 15! D)! 0/#9'#'#?! (-$'8!/@@/8(&#'('$5! 9/8! 8/2$! $#-1#0$;$#(! ^5$$I! $R?RI!J21&! 1#+!g1-#I! EFGLu!:$$8$! 1#+!:/55I!EFFXu!*/$#!$(!12RI!GHHOu!4/l18'/!$(!12RI!EFFNu!A/82+!>$12(-!,8?1#'l1('/#I!EFGX_R!J)!(-$!51;$!(/6$#I!Q/;$#!Q-/!Q/86!9&22W(';$!18$I!1#+!-1C$!D$$#I!;/8$!2'6$2)!(/!$K@$8'$#0$!1!?8$1($8! #"#5,$Q/86! 2/1+! (-1#! ;$#I! D$01&5$! (-$)! &5&122)! 5@$#+! ;/8$! (';$! /#! &#@1'+I!+/;$5('0!Q/86R!B2(';1($2)I!910(/85!5&0-!15!(-/5$!+$508'D$+!1D/C$!18$!2'6$2)!(/!0/#(8'D&($!(/!(-$!?8$1($8I!1#+!Q$22W+/0&;$#($+I!D&8+$#!/9!5(8$55!1#+!;$#(12!'22!-$12(-!1;/#?!Q/;$#!^\8D$8!$(!12RI!GHVOu!72/+$8&5!$(!12RI!EFFHu!38'99'#!$(!12RI!EFFEu!>122I!GHHEu!g81#(l!$(!12RI!EFFO_R!\00/8+'#?2)I!12(-/&?-!(-$5$!8$5&2(5!5-/&2+!D$!'#($8@8$($+!Q'(-!01&('/#I!.(&+)!"c!@8/@/5$5! (-1(! @5)0-/2/?'012! +'5(8$55! 0/#5('(&($5! 1! @/($#('12I! 1#+! -'(-$8(/! 818$2)!106#/Q2$+?$+I!@1(-Q1)!D$(Q$$#!+$;$#('1!1#+!9$;12$!5$KI!/#!(-$!/#$!-1#+I!1#+!+$;$#('1!1#+! 2/Q! $+&01('/#12! 1((1'#;$#(I! /#! (-$! /(-$8R!\++'('/#122)I! (-$! 9'#+'#?5!/9! (-'5! 5(&+)!confirm that education ought to be considered a ‘gendered’ dementia risk factor because /9!(-$!C15(I!5)5($;1('0!'#$%&'('$5!(-1(!-1C$!$K'5($+!D$(Q$$#!;$#!1#+!Q/;$#!'#!($8;5!/9!$+&01('/#12!/@@/8(&#'('$5!(-8/&?-/&(!-'5(/8)R!

<16$#! (/?$(-$8I! (-$5$! 8$5&2(5! 5&@@/8(! (-$! '+$1! (-1(! (-$! -'?-$8! 2'9$(';$! 8'56! /9!+$;$#('1!/D5$8C$+!1;/#?!Q/;$#!'5!#/(I!15!@8$C'/&52)!(-/&?-(I!1((8'D&(1D2$!@8';18'2)!(/!+'99$8$#0$5!'#!2'9$!$K@$0(1#0)!^5$$I!$R?RI!*1l&8$!1#+!.Q$#+5$#I!EFGXu!U$D$2!$(!12RI!EFGVu!4/001!$(!12RI!EFGN_R!.';'2182)I!(-$)!5&??$5(!(-1(!(-$!';@10(!/9!$+&01('/#!/#!+$;$#('1!8'56!'5!2'6$2)!(/!?/!D$)/#+!(-$!@/5'('C$!D81'#!0-1#?$5!&5&122)!155/0'1($+!Q'(-!(-$!0/?#'('C$$'%.%'&%$8()"#8%.-.$^.($8#I!EFFEu!.($8#I!EFGE_I!@18('0&2182)!D$01&5$!$+&01('/#!'5!1!5(8/#?!@8$+'0(/8!/9!'#+'Ciduals’ future labour market position and thus of their economic prospects, their $K@/5&8$! (/! +'99$8$#(!Q/86'#?! 0/#+'('/#5I! (-$'8! 100$55! (/! 5/0'12! 0/##$0('/#5! 1#+! (-$'8!2'9$5()2$W8$21($+!D$-1C'/&85! ^5$$I!$R?RI!J'-1?$#I!EFFFu!J'-1?$#!1#+!>122$8]+I!EFFFu!d'#6!1#+![-$21#I!GHHOu![-$21#!1#+!d'#6I!EFGPu![-$21#!$(!12RI!EFFN_R!=/#5$%&$#(2)I!(-$!8$5&2(5!/9!(-$!@8$5$#(!(-$5'5!5&??$5(!(-1(!8$0/?#'l'#?!02155!1#+!5$KZ?$#+$8!15!9&#+1;$#(12I!1#+!

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The ‘s/!Q-1(?’ question revisited!\22!9/&8!5(&+'$5I!(/?$(-$8!Q'(-!(-$!'#(8/+&0(/8)!@18(5!/9!(-$!(-$5'5I!1#5Q$8!5/;$!%&$5('/#5I!Q-'2$!1(!(-$!51;$!(';$!@/5'#?!1!81#?$!/9!#$Q!/#$5R!U/(Q'(-5(1#+'#?I!(-$)!/99$8!'#5'?-(5!'#(/!1!#&;D$8!/9!5$2+/;2)!8$0/?#'l$+!'#(81Wdisciplinary ‘blindWspots’. In relation to this, I would like to return to the ‘5/!Q-1(i’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provide a fairly concrete example of how ‘household’ sociological knowledge, such as (-$8$!D$'#?!1#!'#($85$0('/#!D$(Q$$#!5)5($;5!/9!5(8&0(&812!^+'5_1+C1#(1?$I!01#!@8/C'+$!#$Q!1#+!+$$@$#$+! '#5'?-(5! '#!/(-$8! 9'$2+5!/9! 8$5$180-R! "#! (&8#I! (-'5!&#+$82'#$5! (-$! 910(! (-1(!5/0'/2/?'5(5!-1C$!';@/8(1#(!0/#(8'D&('/#5!(/!;16$!'#!8$21('/#!(/!/(-$8!+'50'@2'#$5I!5&0-!15!;$+'0'#$I!D)!/99$8'#?!1!(-$/8$('012!1@@181(&5!(-1(!0/&2+!@8/;/($!1!;/8$!#&1#0$+!C'$Q!/9!‘the social’! 1#+! (-$8$D)!@8$C$#(! /C$85';@2'9'01('/#5!/9! '(5! 0/;@2$K'()! ^5$$I! $R?RI! 7/(16'I!EFGGu! 78$$5$I! EFFVu! .-1#1-1#! 1#+! >/9$8I! EFFO_R! d'6$Q'5$I! '(! '5! 02$18! (-1(! '9! 5&0-!0/#(8'D&('/#5!18$!(/!D$!@/55'D2$!1#+!?1'#!'#92&$#0$!'#!/(-$8!9'$2+5I!5/0'/2/?'5(5I!1#+!5/0'12!scientists in general, are equally dependent on the ‘household knowledge’ of other +'50'@2'#$5I!'#!;)!015$!;$+'0'#$!1#+!?$#$('05R!A-'2$!'(!5-/&2+!1?1'#!D$!5(8$55$+!(-1(!#/(!122! 8$5$180-! 65/! /8! .8"*,0! D$! '#($8+'50'@2'#18)I! '(! '5I! 15! 18?&$+! '#! =-1@($8! """I! /9! 6$)!';@/8(1#0$!not to throw out the ‘proverbial baby’ (humility in the face of complexi()_!Q'(-!(-$!D1(-Q1($8!^+'50'@2'#18)!D1((2$5!1#+!+'99$8$#0$5_R!!!

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;)!D$2'$9!(-1(!8$5$180-$85!98/;!+'99$8$#(!+'50'@2'#$5!;&5(!‘join forces’. Finally, as noted in =-1@($8!""!1#+!"cI!12(-/&?-!(-$!155/0'1('/#5!D$(Q$$#!02155Z?$#+$8!1#+!-$12(-!-1C$!D$$#!5&D`$0(! (/! $K($#5'C$! 50'$#('9'0! '#%&'8)I! ;/8$! 8$5$180-! (18?$('#?! (-$! '55&$! /9! -/Q! (-'5!8$21('/#5-'@!C18'$5!/C$8!(';$!'5!08&0'12R!<-'5!'5!@18('0&2182)!@$8('#$#(!'9!Q$!18$!(/!@8/;/($!1! D$(($8! &#+$85(1#+'#?! /9! @/($#('12! D'15! 8$5&2('#?! 98/;I! $R?RI! 5$2$0('C$! ;/8(12'()I! 1#+!thereby the extent to which researchers run the risk of underestimating the ‘true’ impact /9!'#$%&'()!/#!-$12(-!1#+!;/8D'+'()R!

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INEQUITY IN MINDOn the Social and Genetic Risk Factors of Dementia and Their Interactions

Caroline Hasselgren

The word dementia originates from the Latin words de- [out of] and mens [mind]. It is WKH�XPEUHOOD�WHUP�IRU�D�UDQJH�RI�FKLHÀ\�DJH�UHODWHG�GLVRUGHUV�WKDW�RFFXU�DV�D�UHVXOW�RI�damage to, or destruction of, neurons in the brain. Dementia is a devastating condition WKDW�KLWKHUWR� ODFNV�HIIHFWLYH�SUHYHQWLRQ�� WUHDWPHQW�DQG�FXUH��7KXV��DV� ORQJHYLW\�FRQWL-nues to increase in all regions of the world, it has become a public health issue of major FRQFHUQ�WR�DOO�DJHLQJ�VRFLHWLHV��7KH�YDVW�PDMRULW\�RI�GHPHQWLD�FDVHV�RFFXU�WKURXJK�D�FRPSOH[� LQWHUSOD\� EHWZHHQ� JHQHWLF� VXVFHSWLELOLW\� DQG� HQYLURQPHQWDO� H[SRVXUHV�� 7KH�present thesis seeks to further explain the occurrence of Alzheimer’s disease and other GHPHQWLDV�E\�VWXG\LQJ�WKH�ORQJ�WHUP�LPSDFW�RI�FODVV��DQG�JHQGHU�EDVHG�LQHTXLWLHV�DV�ZHOO�DV�WKH�H[WHQW�WR�ZKLFK�WKH\�SRWHQWLDOO\�PRGHUDWH�JHQHWLF�ULVN��7KH�WKHVLV�HQFRPSDV-ses four empirical studies based on data from Swedish prospective cohort studies - all RI�ZKLFK�VKRXOG�EH�FRQVLGHUHG�H[DPSOHV�RI�LQWHUGLVFLSOLQDU\�HIIRUWV�WR�LQFRUSRUDWH�WKHRU\�DQG�H[SHUWLVH�IURP�GLIIHUHQW�¿HOGV�LQ�RUGHU�WR�FUHDWH�D�PRUH�KROLVWLF�XQGHUVWDQGLQJ�RI�GHPHQWLD�DHWLRORJ\�

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INEQUITY IN MIND Caroline Hasselgren

119450_GU_Caroline_Hasselgren_omslag_190909.indd 1 2019-09-09 08:52:31