On the relationship between economic conditions around the time of birth and late life cognitive abilities: Evidence from Taiwan

Direct and indirect associations between childhood socioeconomic status and cognitive function in the middle-aged and older adults in China

OBJECTIVES

To investigate whether childhood socioeconomic status (SES) is associated with cognitive function, and what factors might mediate the associations.

METHOD

Using data from the China Health and Retirement Longitudinal Study (CHARLS) and within frameworks of the latency model, the pathway model and the accumulation model, we quantified direct and indirect pathways between childhood SES and cognitive function for Chinese middle-aged and older adults aged 45+ by structural equations modeling.

RESULTS

We found significant direct, indirect and total effects of childhood SES on cognitive function at baseline. The indirect effects were mediated through educational attainment, household consumption, smoking behaviors and social engagement. At follow-ups, cognitive enhancement can be made by indirect pathways through educational attainment, improvement of household consumption and social engagement.

CONCLUSION

Our results supported the latency model, the pathway model and the accumulation model when considering pathways linking childhood SES to cognitive function. The findings underscored the value of taking early interventions to improve SES and cognitive function, especially among those with low childhood SES.

The Effect of a Tele-Health Intervention Program on Home-Dwelling Persons with Dementia or MCI and on Their Primary Caregivers during the Stay-at-Home-Order Period in the COVID-19 Pandemic Outbreak: Evidence from Taiwan

Background: The Taiwanese government implemented a stay-at-home order that restricted all community-based health promotion activities for the elderly by shutting down all community care centers from May 2021 to August 2021 to control the spread of COVID-19. Community-based dementia care centers were barely able to provide dementia care services during that period. Methods: The data used in this study were collected from a community-based dementia care center that was able to continue their dementia care services through a Tele-Health intervention program. The difference-in-differences methodology was applied to evaluate the effects of the Tele-Health intervention program on home-dwelling persons with dementia or mild cognitive impairment and on their primary caregivers during the COVID-19 pandemic. Results: The Tele-Health intervention program significantly increased the well-being of the participants and their primary caregivers, but the negative correlations between the Tele-Health intervention program and family functioning were also found to be significant. Conclusions: The significant substitution (negative) effects between the Tele-Health intervention program and family functioning raises the concern that promotion of the Tele-Health intervention program comes at the potential cost of a loss of family functioning. Policymakers should be cautious when considering the Tele-Health intervention program in response to pandemics and demographic transitions.

Education-related health inequities in noncommunicable diseases: an analysis of the Brazilian National Health Survey, 2013 and 2019

This study assesses changes in the prevalence and distribution of noncommunicable diseases (NCDs) and related risk factors among Brazilian adults from the 2013 and 2019 Brazilian National Health Surveys (PNS). It is based on the hypothesis that deteriorating socioeconomic conditions over this period would lead to increased NCDs among the least advantaged populations. We estimated adjusted prevalence ratios by education category and three inequality measures - the slope index of inequality (SII), the relative index of inequality (RII), and population attributable fraction (PAF) - for obesity, hypertension, arthritis, asthma, cancer, depression, diabetes, heart disease, having any chronic condition, and multimorbidity by survey year. We also estimated the 27 Brazilian Federative Units RII and prevalence rates for diabetes and multimorbidity per year and plotted the RII against prevalence by year. Results showed that all NCDs increased over the period observed, ranging from an 8% increase in the adjusted prevalence of arthritis to a 24% increase in the adjusted prevalence of obesity. Measures of inequality showed that most conditions exhibited significant educational inequities in both 2013 and 2019. However, on average, education-based inequities did not significantly change between the two periods. Considering the deterioration of the socioeconomic conditions of most Brazilians, the erosion of social protections, and the continuing economic, political, and health crises occurring in the nation, we observed an urgent need for discussion about the best way to adopt equity-promoting health policies and programs and action to reduce socioeconomic and geographic inequalities in NCDs throughout the country.

Social relations and health in older people in Spain using SHARE survey data

Introduction

Social relationships (SR) are an important aspect in the healthy ageing process. The study aimed to describe SR in over-50s in Spain and analyse their association with physical/emotional, functional and cognitive/sensory health variables.

Methods

The study sample was formed by 5583 people representing the Spanish population aged 50 and over, who participated in the sixth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE). The variables were divided into socio-demographic aspects and economic, health and SR aspects represented by the number of friends, family members and satisfaction with social network and the Revised UCLA loneliness scale. The health variables were grouped using a main component analysis. Multiple linear regressions were performed between the health components with socio-demographic and SR variables.

Results

67.26% of respondents said they did not feel lonely. The feeling of loneliness was the variable most closely related to the physical and emotional, functional and cognitive and sensory health components. The main SR variable associated to health components was the Revised UCLA Loneliness Scale (standardised beta, p < 0.001; p < 0.001; and p < 0.001, respectively). The number of family members in social network SR variable was also associated with the physical/emotional health (β = 0.09, p < 0.001) and cognitive/sensory ability (β = 0.10, p = 0.001) components.

Conclusions

The main SR aspect that impacts health status was loneliness. The results of this study suggest the importance of developing public health policies oriented to promoting action on the SR characteristics that enhance older people’s health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02975-y.

The relationship between early-life conditions in the home country and adult outcomes among child immigrants in the United States

We examine the impact of health and economic conditions at birth on the adult outcomes of child immigrants using the Children of Immigrants Longitudinal Study. Our sample consists of children from 39 countries who were brought to the United States before the age of 13. We estimate immigrant outcomes as a function of the infant mortality rate (IMR) and GDP per capita of their home country in the year of birth, controlling for birth-year, year-of-arrival and country-of-birth fixed effects, as well as demographic characteristics. IMR has a significant negative impact on English reading ability and GPA in middle school. IMR significantly decreases first job prestige, years of schooling, working hours and log earnings. Some of these effects appear to be working through the lower middle school GPA. IMR does not influence self-rated health or labor market participation in adulthood, and there is no statistically significant relationship between GDP per capita and adult outcomes. Detrimental effects of IMR are significantly lower for children who arrived younger and whose parents have high school degree or above. Our estimates are of economic significance: the impact of being born in 1975 versus 1976 in Nicaragua in terms of the impact of IMR on earnings is equal to the gender effect on earnings. Our results cannot be explained by selection on observables: the pre-migration characteristics of children and parents are not associated significantly with the health and economic conditions at birth. Also, several tests show that our results cannot be explained by potential selection on unobservables.

Disparity in Educational Attainment Partially Explains Cognitive Gender Differences in Older Rural South Africans

OBJECTIVES

Direction and magnitude of gender differences in late-life cognitive function are inextricably tied to sociocultural context. Our study evaluates education and literacy as primary drivers of gender equality in cognitive performance among middle-aged and older adults in rural South Africa.

METHOD

Data were collected on 1,938 participants aged 40-79 from Agincourt, South Africa. Cognitive function was measured via the Oxford Cognitive Screen-Plus, a tablet-based assessment with low literacy demands. Four cognitive domains were derived through confirmatory factor analysis: episodic memory, executive function, visual spatial, and language. Structural equation models tested domain-specific gender effects, incrementally controlling for demographic, education, health, and socioeconomic variables.

RESULTS

In the model adjusting only for demographic factors, men outperformed women on executive function and visual-spatial domains. Adding education and literacy to the model revealed a robust female advantage in episodic memory, and reduced the magnitude of male advantage in executive function and visual and spatial by 47% and 42%, respectively. Health and socioeconomic factors did not alter patterns of gender associations in subsequent models.

DISCUSSION

In this older South African cohort, gender inequality in cognitive performance was partially attributable to educational differences. Understanding biopsychosocial mechanisms that promote cognitive resilience in older women is critically important given the predominantly female composition of aging populations worldwide.

The Relationship between Clinic Visit Accompanied by Family and Dementia Severity in Taiwan

INTRODUCTION

This study analyzes the severity of dementia status with clinical dementia rating (CDR) score distribution among patients according to various family functional and sociodemographic issues.

METHODS

A cross-sectional study was performed in a regional hospital in Central Taiwan. The sample consisted of 318 patients who came to the clinic from May 2018 to April 2019, and who were diagnosed by the physicians with CDR scores ≧ 0.5. The Chi-Square test and binary logistic regression analyses were performed for inferential statistical analysis.

RESULTS

The mean age of the sample was 78.7 ± 8.51 years, and 61.6% of the samples' CDR scores were equal or less than 1.0. Patients visiting the clinic were accompanied by spouses (21.7%), sons or daughters-in-law (40.6%), daughters (23.6%). Of the sample, 142 (44.3%) patients live with sons. Patients with a lower educational level had higher CDR scores. Compared to the patients who went to the clinic by themselves, the higher OR values of CDR scores ≧ 2 are found in patients who were accompanied by other relatives (OR = 18.871, 95% C.I. = 3.117-114.237, p = 0.001), or spouse (OR = 10.783, 95% C.I. = 1.996-58.245, p = 0.006).

CONCLUSION

The family member who accompanied the patient to a clinic visit and the patient's educational level are both significant issues relating to the severity of dementia.

The legacy lead deposition in soils and its impact on cognitive function in preschool-aged children in the United States

Surface soil contamination has been long recognized as an important pathway of human lead exposure, and is now a worldwide health concern. This study estimates the causal effects of exposure to lead in topsoil on cognitive ability among 5-year-old children. We draw on individual level data from the 2000 U.S. Census, and USGS data on lead in topsoil covering a broad set of counties across the United States. Using an instrumental variable approach relying on the 1944 Interstate Highway System Plan, we find that higher lead in topsoil increases considerably the probability of 5-year-old boys experiencing cognitive difficulties such as learning, remembering, concentrating, or making decisions. Living in counties with topsoil lead concentration above the national median roughly doubles the probability of 5-year-old boys having cognitive difficulties. Nevertheless, it does not seem to affect 5-year-old girls, consistent with previous studies. Importantly, the adverse effects of lead exposure on boys are found even in counties with levels of topsoil lead concentration considered low by the guidelines from the U.S. EPA and state agencies. These findings are concerning because they suggest that legacy lead may continue to impair cognition today, both in the United States and in other countries that have considerable lead deposition in topsoil.

Associations of childhood socioeconomic status with mid-life and late-life cognition in Chinese middle-aged and older population based on a 5-year period cohort study

OBJECTIVES

A prospective study was performed to examine the relationship of childhood socioeconomic status (SES) with cognition and the rate of change in a nationally representative sample of community-dwelling middle-aged and older Chinese population.

METHODS

This study mainly focused on 3 composite measures of cognitive function, including Telephone Interview of Cognitive Status, word recall, and drawing a figure successfully. Childhood SES was evaluated by parental occupation and education, childhood residence, and self-evaluated financial status. We designed an analysis strategy adding predictors incrementally in different models to examine the changes of effects of childhood SES on cognition by latent growth curve models.

RESULTS

Finally, a total of 10 533 respondents were prospectively studied, including 5980 respondents aged 45-59 and 4553 aged 60-90. Cognition in younger cohort showed a curvilinear change, while cognition in older cohort showed a linear decline. After controlling for covariates, middle-aged respondents with higher self-evaluated financial status (β: -0.22, P < .001), better health status (β: -0.13, P < .001), higher parental education (β: 0.17 and 0.10, P < .001), who had lived in city/town before 16 years (β: 0.69, P < .001), and whose fathers engaged in nonfarming work (β: 0.43, P < .001) were associated with the better baseline cognition. Similar results were found in older cohort. Additionally, early-life SES was not associated with cognitive decline in both cohorts.

CONCLUSIONS

This study indicates that childhood SES is associated with mid-life and late-life baseline cognition, but it is not contributed to cognition decline. Interventions in early-life focused on improving childhood SES might have positive impacts on baseline cognition in later-life.

Inequality in old age cognition across the world

Although cohort and country differences in average cognitive levels are well established, identifying the degree and determinants of inequalities in old age cognitive functioning could guide public health and policymaking efforts. We use all publicly available and representative old age surveys with comparable information to assess inequalities of cognitive functioning for six distinctive age groups in 29 countries. We document that cognitive inequalities in old age are largely determined by earlier educational inequalities as well as gender differential survival rates. For example, a one percentage point increase in the Gini index of past education is associated with an increase of 0.45 percentage points in the Gini index of delayed recall and 0.23 percentage points in the Gini of immediate recall. Results are robust to a variety of alternative explanations and persist even after controlling for gender-related biases in survival rates. Furthermore, we find evidence that unequal opportunities for education -captured by differences in parental background and gender- also have significant effects on inequality of old age cognition.

Multidimensional human capital formation in a developing country: Health, cognition and locus of control in the Philippines

Economic success depends on multiple human capital stocks whose production is interrelated and occurs over many life stages. Yet, much empirical work fails to account for human capital's multidimensional nature and limits its focus to specific childhood stages. Using longitudinal data from the Philippines, I estimate a model of multidimensional human capital formation from birth through adulthood where health, cognitive, and noncognitive dimensions are jointly produced. I examine during which developmental stages parental investment is most influential and address the endogeneity of investment using a policy function where investment depends on child characteristics, exogenous conditions at birth and local prices. Findings imply that not only will early human capital disparities persist into adulthood without early remediation but also that cognitive gains yielded from early remediation will be lost without complementary investment in adolescence. Findings further suggest that interventions will be undervalued if their multidimensional effects are not accounted for.

Heterogeneity in the long term health effects of warfare

This paper estimates the long-term heterogeneous legacies of exposures to war in utero and during early childhood on height in adulthood. Using a novel dataset on the regional WWII destruction in Germany, combined with the German Socio-Economic Panel (SOEP), we find that individuals who experienced warfare in utero and during childhood are an average of 2cm shorter as adults, suggesting that the negative scarring effect of WWII dominated the positive effect coming from a selection. Among war survivors, children from less privileged families who resided in highly destroyed regions, particularly girls, suffered the greatest health consequences of warfare. Our analyses also show that wartime children who lost their parents during the war years are an average of 1.3cm shorter as adults. However, the father's conscription during WWII had no long-term effect on adult height.

Childhood deprivation and later-life cognitive function in a population-based study of older rural South Africans

RATIONALE

Little research has evaluated the life course drivers of cognitive aging in South Africa.

OBJECTIVES

We investigated the relationships of self-rated childhood health and father's occupation during childhood with later-life cognitive function score and whether educational attainment mediated these relationships among older South Africans living in a former region of Apartheid-era racial segregation.

METHODS

Data were from baseline assessments of "Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community" (HAALSI), a population-based study of 5059 men and women aged ≥40 years in 2015 in rural Agincourt sub-district, South Africa. Childhood health, father's occupation during childhood, and years of education were self-reported in study interviews. Cognitive measures assessed time orientation, numeracy, and word recall, which were included in a z-standardized latent cognitive function score variable. Linear regression models adjusted for age, sex, and country of birth were used to estimate the total and direct effects of each childhood risk factor, and the indirect effects mediated by years of education.

RESULTS

Poor childhood health predicted lower cognitive scores (total effect = -0.28; 95% CI = -0.35, -0.21, versus good); this effect was not mediated by educational attainment. Having a father in a professional job during childhood, while rare (3% of sample), predicted better cognitive scores (total effect = 0.25; 95% CI = 0.10, 0.40, versus unskilled manual labor, 29% of sample). Half of this effect was mediated by educational attainment. Education was linearly associated with later-life cognitive function score (0.09; 95% CI = 0.09, 0.10 per year achieved).

CONCLUSION

In this post-Apartheid, rural South African context, older adults with poor self-reported childhood health or whose father worked in unskilled manual labor had relatively poor cognitive outcomes. Educational attainment strongly predicted cognitive outcomes, and appeared to be, in part, a mechanism of social stratification in later-life cognitive health in this context.

Health and income inequalities in Europe: What is the role of circumstances?

Equality of opportunity theories distinguish between inequalities due to individual effort and those due to external circumstances. Recent research has shown that half of the variability in income of World population was determined by country of birth and income distribution. Since health and income are generally strictly related, the aim of this paper is to estimate how much variability in income and health is determined by external circumstances. We use data from the Survey of Health, Ageing and Retirement (SHARE) and the English Longitudinal Survey on Ageing (ELSA), two comparable multidisciplinary surveys that provide micro-level data on health and financial resources among the elderly for a large number of European countries. Our baseline estimation shows that about 20% of the variability in income is explained by current country-specific circumstances, while health outcomes range from 12% using BMI to 19% using self-rated health. By including early-life circumstances, the explained variability increases almost 20 percentage points for income and for self-rated health but less for other health outcomes. Finally, by controlling for endogeneity issues linked with effort, our estimates indicate that circumstances better explain variability in health outcomes. Results are robust to some tests, and the implications of these findings are discussed.