Impact of educational attainment on time to cognitive decline among marginalized older adults: Cohort study of 20,311 adults
Corresponding Author
Dylan J. Jester PhD, MPH
Department of Psychiatry, University of California San Diego, La Jolla, California, USA
Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
Correspondence
Dylan J. Jester, Sam and Rose Stein Institute for Research on Aging & Department of Psychiatry, University of California San Diego School of Medicine, 9500 Gilman Drive 0664, La Jolla, CA 92093, USA.
Email: [email protected]
Search for more papers by this authorBarton W. Palmer PhD
Department of Psychiatry, University of California San Diego, La Jolla, California, USA
Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
Psychology Division, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
Search for more papers by this authorMichael L. Thomas PhD
Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
Search for more papers by this authorLauren L. Brown PhD, MPH
Division of Health Management and Policy, School of Public Health, San Diego State University, San Diego, California, USA
Search for more papers by this authorLize Tibiriçá PsyD
Department of Psychiatry, University of California San Diego, La Jolla, California, USA
Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
Search for more papers by this authorDilip V. Jeste MD
Department of Psychiatry, University of California San Diego, La Jolla, California, USA
Search for more papers by this authorTodd Gilmer PhD
Herbert Wertheim School of Public Health, University of California San Diego, San Diego, California, USA
Search for more papers by this authorCorresponding Author
Dylan J. Jester PhD, MPH
Department of Psychiatry, University of California San Diego, La Jolla, California, USA
Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
Correspondence
Dylan J. Jester, Sam and Rose Stein Institute for Research on Aging & Department of Psychiatry, University of California San Diego School of Medicine, 9500 Gilman Drive 0664, La Jolla, CA 92093, USA.
Email: [email protected]
Search for more papers by this authorBarton W. Palmer PhD
Department of Psychiatry, University of California San Diego, La Jolla, California, USA
Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
Psychology Division, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
Search for more papers by this authorMichael L. Thomas PhD
Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
Search for more papers by this authorLauren L. Brown PhD, MPH
Division of Health Management and Policy, School of Public Health, San Diego State University, San Diego, California, USA
Search for more papers by this authorLize Tibiriçá PsyD
Department of Psychiatry, University of California San Diego, La Jolla, California, USA
Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
Search for more papers by this authorDilip V. Jeste MD
Department of Psychiatry, University of California San Diego, La Jolla, California, USA
Search for more papers by this authorTodd Gilmer PhD
Herbert Wertheim School of Public Health, University of California San Diego, San Diego, California, USA
Search for more papers by this authorAbstract
Background
The effect of years of education on the maintenance of healthy cognitive functioning may differ by race and ethnicity given historical and ongoing inequities in educational quality.
Methods
We examined 20,311 Black, Latinx, and White adults aged 51–100 from the Health and Retirement Study (2008–2016). Telephone Interview for Cognitive Status-27 data was used to measure cognitive functioning. Generalized additive mixed models were stratified by race and ethnicity and educational attainment (≥12 vs. <12 years). Selected social determinants of health, all-cause mortality, time-varying health and healthcare utilization characteristics, and study wave were included as covariates.
Results
On average, Black and Latinx adults scored lower at baseline compared to White adults regardless of educational attainment (p < 0.001), with a significant overlap in the distributions of scores. The rate of cognitive decline was non-linear for Black, Latinx, and White adults (p < 0.001), and a period of stability was witnessed for those with higher educational attainment irrespective of race and ethnicity. Compared to Black, Latinx, and White adults with lower educational attainment, higher-educated White adults received the greatest protection from cognitive decline (13 years; 64 vs. 51), followed by Latinx (12 years; 67 vs. 55), and Black adults (10 years; 61 vs. 51). Latinx adults experienced cognitive decline beginning at a later age.
Conclusions
The extent to which higher educational attainment protects adults from cognitive decline differs by race and ethnicity, such that higher-educated White adults received a greater benefit than higher-educated Black or Latinx adults.
CONFLICT OF INTEREST STATEMENT
The authors declare that there is no conflict of interest.
Supporting Information
| Filename | Description |
|---|---|
| jgs18340-sup-0001-Figures.pdfPDF document, 522.3 KB | Supplemental Figure S1. Inclusion criteria for the analytic sample. Supplemental Figure S2. Derivative plot of the generalized additive mixed models by race and ethnicity and by years of education from 51 to 100 years of age. Each generalized additive mixed model was broken into 1,000 sections and the first derivative was plotted by age. In some cases where the derivative was close to zero or positive, a later age of decline was chosen after careful inspection of the regression lines reported in Figure 2. The shaded area around the point estimate is the 95% confidence interval. Supplemental Figure S3. Sensitivity analyses of the generalized additive mixed models where mother's and father's education were excluded as covariates. Two covariates had missing data at greater levels than 5% (mother's education at 9%, father's education at 16%). GAMMs were reanalyzed with the 4,910 additional participants excluded due to missingness on these two covariates. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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