Introduction: Previous studies have shown that people with low socioeconomic status have more white matter hyperintensities (WMH) when they get older. In this study, we wanted to analyze to what extent education and income explain differences in WMH. Further, we wanted to identify lifestyle risk factors that are associated with WMH among people with low and high education or income.

Methods: A total of n = 1,185 dementia-free participants aged 40–80 years from the population-based study of the Leipzig Research Centre for Civilization Diseases (LIFE) in Leipzig, Germany, were analyzed. Information was obtained in standardized interviews. WMH (including the derived Fazekas scores) were assessed using automated segmentation of high- resolution T1-weighted anatomical and fluid-attenuated inversion recovery (FLAIR) MRI.

Results: Income and WMH were significantly associated in univariate analyses but did not remain statistically significant after adjusting for age, gender, arterial hypertension, heart disease, and APOE e4 allele. Education was significantly associated with Fazekas scores but not with WMH and not after Bonferroni correction. After combining the lifestyle risk factors in a factor analysis, results from adjusted models indicated only statistically significant associations between higher distress and more WMH as well as between obesity and deeper WMH.

Discussion: Differences in WMH between individuals with low and high education or income may be the result form differences in risk factors. Further research needs to explore the potential pathways.