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Lee AR, Torres J, Flores Romero KR. Adult Child Financial Disadvantage and the Cognitive Trajectories Among Older Parents in the United States. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae123. [PMID: 39021093 PMCID: PMC11304953 DOI: 10.1093/geronb/gbae123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVES Adult child socioeconomic status (SES) has been identified as a predictor of older parents' cognitive aging. However, studies have primarily relied on educational attainment as the sole measure of adult child SES. We evaluated the relationship between adult children's financial disadvantage and cognitive outcomes of older parents in the United States. METHODS We used data from U.S. Health and Retirement Study (2000-2014, n = 15,053 respondents ≥51 years with at least 1 adult child). Adult child financial disadvantage was measured with 3 indicators of extremely low income, unemployment, and lack of homeownership. We used linear mixed models to estimate the association between adult child financial disadvantage and the rate of decline in verbal memory scores, controlling for respondents' sociodemographic characteristics. RESULTS Having at least 1 adult child (vs no adult children) with extremely low income was found to be associated with lower verbal memory (b = -0.041, 95% confidence interval [CI]: -0.043, -0.039) at baseline. There was a small but significant association with the rate of decline in verbal memory z-scores (b = 0.004, 95% CI: 0.000, 0.008) and some evidence of heterogeneity by parent gender, marital status, and SES. DISCUSSION Offspring financial disadvantage may be influential for older parents' initial level of memory function, although evidence of associations with memory decline was weak. Public policy interventions aimed at improving the economic conditions of adult children may indirectly benefit the cognitive performance of disadvantaged parents in their later life.
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Affiliation(s)
- Ah-Reum Lee
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Jacqueline Torres
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Karla Renata Flores Romero
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
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van Allen Z, Orsholits D, Boisgontier MP. Pre-stroke physical activity matters for functional limitations: A longitudinal case-control study of 12,860 participants. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.09.14.23295576. [PMID: 37745591 PMCID: PMC10516084 DOI: 10.1101/2023.09.14.23295576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Objective In the chronic phase after a stroke, limitations in activities of daily living (ADLs) and instrumental ADL (IADLs) initially plateau before steadily increasing. The benefits of pre-stroke physical activity on these limitations remain unclear. To clarify this relationship, we examined the effect of physical activity on the long-term evolution of functional limitations in a cohort of stroke survivors and compared it to a cohort of matched stroke-free adults. Methods Longitudinal data from 2,143 stroke survivors and 10,717 stroke-free adults aged 50 years and older were drawn from a prospective cohort study based on the Survey of Health, Ageing and Retirement in Europe (2004-2022; 8 data collection waves). Physical activity was assessed in the pre-stroke wave. Functional limitations were assessed in the post-stroke waves. Each stroke survivor was matched with 5 stroke-free adults who had similar propensity scores computed on the basis of key covariates, including baseline age, sex, body mass index, limitations in ADL and IADL, chronic conditions and country of residence, before any of the participants from either cohort had experienced a stroke. Results Results showed an interaction between stroke status and physical activity on ADL limitations (b = -0.076; 95% CI = -0.142 to -0.011), with the effect of physical activity being stronger in stroke survivors (b = -0.345, 95% CI = -0.438 to -0.252) than in stroke-free adults (b = -0.269, 95% CI = -0.269 to -0.241). Conclusion The beneficial effect of pre-stroke physical activity on ADL limitations after stroke is stronger than its effect in matched stroke-free adults followed for a similar number of years. Impact Physical activity, an intervention within the physical therapist's scope of practice, is effective in reducing the risk of functional dependence after stroke. Moreover, pre-stroke levels of physical activity can inform the prognosis of functional dependence in stroke survivors.
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Affiliation(s)
- Zack van Allen
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Canada
- Perley Health Centre of Excellence in Frailty-Informed Care, Ottawa, Canada
| | - Dan Orsholits
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Canada
| | - Matthieu P. Boisgontier
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Canada
- Perley Health Centre of Excellence in Frailty-Informed Care, Ottawa, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Canada
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Baranova A, Cao H, Zhang F. Exploring the influences of education, intelligence and income on mental disorders. Gen Psychiatr 2024; 37:e101080. [PMID: 38440407 PMCID: PMC10910399 DOI: 10.1136/gpsych-2023-101080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 01/24/2024] [Indexed: 03/06/2024] Open
Abstract
Background Previous studies have shown that educational attainment (EA), intelligence and income are key factors associated with mental disorders. However, the direct effects of each factor on major mental disorders are unclear. Aims We aimed to evaluate the overall and independent causal effects of the three psychosocial factors on common mental disorders. Methods Using genome-wide association study summary datasets, we performed Mendelian randomisation (MR) and multivariable MR (MVMR) analyses to assess potential associations between the 3 factors (EA, N=766 345; household income, N=392 422; intelligence, N=146 808) and 13 common mental disorders, with sample sizes ranging from 9907 to 807 553. Inverse-variance weighting was employed as the main method in the MR analysis. Results Our MR analysis showed that (1) higher EA was a protective factor for eight mental disorders but contributed to anorexia nervosa, obsessive-compulsive disorder (OCD), bipolar disorder (BD) and autism spectrum disorder (ASD); (2) higher intelligence was a protective factor for five mental disorders but a risk factor for OCD and ASD; (3) higher household income protected against 10 mental disorders but confers risk for anorexia nervosa. Our MVMR analysis showed that (1) higher EA was a direct protective factor for attention-deficit/hyperactivity disorder (ADHD) and insomnia but a direct risk factor for schizophrenia, BD and ASD; (2) higher intelligence was a direct protective factor for schizophrenia but a direct risk factor for major depressive disorder (MDD) and ASD; (3) higher income was a direct protective factor for seven mental disorders, including schizophrenia, BD, MDD, ASD, post-traumatic stress disorder, ADHD and anxiety disorder. Conclusions Our study reveals that education, intelligence and income intertwine with each other. For each factor, its independent effects on mental disorders present a more complex picture than its overall effects.
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Affiliation(s)
- Ancha Baranova
- George Mason University, Fairfax, Virginia, USA
- Research Centre for Medical Genetics, Moscow, Russia
| | - Hongbao Cao
- George Mason University, Fairfax, Virginia, USA
| | - Fuquan Zhang
- Nanjing Medical University Affiliated Brain Hospital, Nanjing, Zhejiang, China
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Cheval B, Maltagliati S, Saoudi I, Fessler L, Farajzadeh A, Sieber S, Cullati S, Boisgontier MP. Physical activity mediates the effect of education on mental health trajectories in older age. J Affect Disord 2023; 336:64-73. [PMID: 37217099 DOI: 10.1016/j.jad.2023.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Why people with lower levels of educational attainment have poorer mental health than people with higher levels can partly be explained by financial circumstances. However, whether behavioral factors can further explain this association remains unclear. Here, we examined the extent to which physical activity mediates the effect of education on mental health trajectories in later life. METHODS Data from 54,818 adults 50 years of age or older (55 % women) included in the Survey of Health, Aging and Retirement in Europe (SHARE) were analyzed using longitudinal mediation and growth curve models to estimate the mediating role of physical activity (baseline and change) in the association between education and mental health trajectories. Education and physical activity were self-reported. Mental health was derived from depressive symptoms and well-being, which were measured by validated scales. RESULTS Lower education was associated with lower levels and steeper declines in physical activity over time, which predicted greater increases in depressive symptoms and greater decreases in well-being. In other words, education affected mental health through both levels and trajectories of physical activity. Physical activity explained 26.8 % of the variance in depressive symptoms and 24.4 % in well-being, controlling for the socioeconomic path (i.e., wealth and occupation). CONCLUSIONS These results suggest that physical activity is an important factor in explaining the association between low educational attainment and poor mental health trajectories in adults aged 50 years and older.
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Affiliation(s)
- Boris Cheval
- Swiss Center for Affective Sciences, University of Geneva, Switzerland; Laboratory for the Study of Emotion Elicitation and Expression (E3Lab), Department of Psychology, University of Geneva, Switzerland.
| | | | - Ilyes Saoudi
- Univ. Grenoble Alpes, SENS, F-38000 Grenoble, France
| | - Layan Fessler
- Univ. Grenoble Alpes, SENS, F-38000 Grenoble, France
| | - Ata Farajzadeh
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Canada; Bruyère Research Institute, Ottawa, Canada
| | - Stefan Sieber
- LIVES Centre, Swiss Centre of Expertise in Life Course Research, University of Lausanne, Switzerland
| | - Stéphane Cullati
- Population Health Laboratory, University of Fribourg, Switzerland; Department of Readaptation and Geriatrics, University of Geneva, Switzerland
| | - Matthieu P Boisgontier
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Canada; Bruyère Research Institute, Ottawa, Canada
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5
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Li Q, Gu J, Huang J, Zhao P, Luo C. "They see me as mentally ill": the stigmatization experiences of Chinese menopausal women in the family. BMC Womens Health 2023; 23:185. [PMID: 37076835 PMCID: PMC10116657 DOI: 10.1186/s12905-023-02350-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/12/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Menopausal women are regarded as "abnormal people" in China and are often discriminated against and ostracized, especially in the privacy of their homes. However, research on the stigmatization of menopausal women in China is limited. The aim of this study is to explore and describe the stigmatization experiences of Chinese menopausal women in the family and their feelings about these experiences. METHODS A phenomenological qualitative research design involving in-depth semi-structured interviews was selected. Our data analysis adopted Colaizzi's methodology. RESULTS Fourteen menopausal women participated in this study. Four themes and 12 subthemes emerged: (1) violent treatment (verbal and physical violence); (2) lack of attention and companionship (lack of understanding of physical and psychological suffering, neglect of the value of labour and difficulty finding someone to talk to and accompany them); (3) coping struggles (keeping quiet, fighting back, changing inappropriate perceptions and developing a menopausal transition management plan); and (4) despair (deep-rooted perceptions, restrictions on travel and consumption, and unknown "healing" times). CONCLUSION Our results suggest that Chinese menopausal women suffer physically and mentally within their families. The stigma of menopause is both a symptom of the broad societal lack of knowledge regarding menopause and a reflection of the patriarchal oppression of women in a specific cultural context. Accordingly, this study can help menopausal women and society in general better understand the former's stigmatization experiences and amplify their inner voices. Moreover, it can serve as a reference for the formulation of menopause-related health policies in China and for advocating and promoting humanistic care for menopausal women.
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Affiliation(s)
- Qiong Li
- School of Public Administration, Hohai University, Nanjing, 211100, China
| | - Jintu Gu
- Department of Sociology, Hohai University, Nanjing, China.
- Research Center for Environment and Society, Hohai University, Nanjing, China.
- Yangtze Institute for Conservation and High-quality Development, Jiangsu Research Base, Nanjing, China.
| | - Jianyuan Huang
- School of Public Administration, Hohai University, Nanjing, 211100, China
| | - Pei Zhao
- Jiangsu Province Hospital, Nanjing, 211100, China.
| | - Chenliang Luo
- Shanghai Pudong New Area Tax Bureau, State Taxation Administration, Shanghai, 200120, China
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Joo WT. Educational gradient in social network changes at disease diagnosis. Soc Sci Med 2023; 317:115626. [PMID: 36586184 PMCID: PMC10039803 DOI: 10.1016/j.socscimed.2022.115626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/15/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
This study examines the educational gradient in social network changes following the diagnosis of new chronic diseases. Using a representative sample of the US older population, the author shows that the network size and amount of health-related discussion with social network members increased only for older adults with a bachelor's degree. Tie-level analyses reveal that such increase is from the activation of health discussion with the existing social network members, but not from the changes in discussion partners. These results suggest that heterogeneous temporal dynamics in social networks may be one mechanism that shapes diverging health trajectories in later life.
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Affiliation(s)
- Won-Tak Joo
- Department of Demography, University of California, Berkeley, 328 Social Sciences Building, Berkeley, CA, 94720, USA.
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Su J, Xiao X. Factors leading to the trajectory of cognitive decline in middle-aged and older adults using group-based trajectory modeling: A cohort study. Medicine (Baltimore) 2022; 101:e31817. [PMID: 36451491 PMCID: PMC9704883 DOI: 10.1097/md.0000000000031817] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Currently, studies exploring factors associated with the cognition at some time point and no study identifying the trajectories of cognitive changes and factors might associate with the trajectories of cognitive changes in people. This study was to identify factors associated with the trend of cognitive decline in middle-aged and older people. In this cohort study, the data of 6954 subjects were collected from China Health and Retirement Longitudinal Survey database. Group-based trajectory modeling was applied for identifying three different trajectories of cognitive function change [high initial level and slow decline group (n = 1024), moderate initial level and moderate decline group (n = 2673) and low initial level and rapid decline (LRD) group (n = 3277)]. Univariate and multivariate logistic regression analysis was conducted to identify variables influencing factors of the trajectories of cognitive function in middle-aged and older people. The follow-up interval was 2 years from 2011 to 2015, and 3 years from 2015 to 2018 via face-to-face interview. High initial level and slow decline group versus LRD group, age (OR = 2.591, 95% CI: 1.962-3.421), gender (OR = 1.398, 95% CI: 1.133-1.725), education (OR = 0.051, 95% CI: 0.039-0.068), place of residence (OR = 2.768, 95% CI: 1.663-4.606), disabled (OR = 1.557, 95% CI: 1.189-2.039), family annual income (OR = 0.757, 95% CI: 0.618-0.929), sleep duration (OR = 1.266, 95% CI: 1.023-1.567), instrumental activity of daily living impairment (OR = 2.513, 95% CI: 1.947-3.245), community activities participation (OR = 0.611, 95% CI: 0.500-0.748), depression (OR = 1.471, 95% CI: 1.185-1.828), and systolic blood pressure (OR = 1.005, 95% CI: 1.001-1.009) were factors influencing the trajectories of cognitive function. Comparing moderate initial level and moderate decline group and LRD group, age (OR = 1.245, 95% CI: 1.052-1.474), gender (OR = 1.244, 95% CI: 1.062-1.458), education (OR = 0.244, 95% CI: 0.190-0.314), marital status (OR = 1.291, 95% CI: 1.079-1.546), place of residence (OR = 1.677, 95% CI: 1.358-2.071), disability (OR = 1.396, 95% CI: 1.180-1.652), smoking (OR = 1.249, 95% CI: 1.071-1.457), family annual income (OR = 0.863, 95% CI: 0.768-0.970), sleep duration (OR = 1.215, 95% CI: 0.973-1.541), instrumental activity of daily living impairment (OR = 1.309, 95% CI: 1.098-1.560), community activities participation (OR = 0.804, 95% CI: 0.718-0.900) and depression (OR = 1.383, 95% CI: 1.217-1.571) were factors associated with the trajectories of cognitive function changes. Middle-aged and older adults who had characteristics associated with increased risk of cognitive decline might be provided with timely interventions.
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Affiliation(s)
- Jun Su
- Department of Neurology, the First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
- * Correspondence: Jun Su, Department of Neurology, the First Affiliated Hospital of Shenzhen University, No. 3002 Sungang West Road, Futian District, Shenzhen 518035, China (e-mail: )
| | - Xiaohua Xiao
- Department of Geriatric Medicine, the First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
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8
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Kraft P, Kraft B, Hagen T, Espeseth T. Subjective Socioeconomic Status, Cognitive Abilities, and Personal Control: Associations With Health Behaviours. Front Psychol 2022; 12:784758. [PMID: 35153907 PMCID: PMC8831894 DOI: 10.3389/fpsyg.2021.784758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo examine subjective and objective socioeconomic status (SSES and OSES, respectively) as predictors, cognitive abilities as confounders, and personal control perceptions as mediators of health behaviours.DesignA cross-sectional study including 197 participants aged 30–50 years, recruited from the crowd-working platform, Prolific.Main Outcome MeasureThe Good Health Practices Scale, a 16-item inventory of health behaviours.ResultsSSES was the most important predictor of health behaviours (beta = 0.19, p < 0.01). Among the OSES indicators, education (beta = 0.16, p < 0.05), but not income, predicted health behaviours. Intelligence (r = −0.16, p < 0.05) and memory (r = −0.22, p < 0.01) were negatively correlated with health-promoting behaviours, and the effect of memory was upheld in the multivariate model (beta = −0.17, p < 0.05). Personal control perceptions (mastery and constraints) did not act as mediators.ConclusionSSES predicted health behaviours beyond OSES. The effect of socioeconomic indicators was not confounded by cognitive abilities. Surprisingly, cognitive abilities were negatively associated with health-promoting behaviours. Future research should emphasise SSES as a predictor of health behaviours. Delineating the psychological mechanisms linking SSES with health behaviours would be a valuable contribution toward improved understanding of socioeconomic disparities in health behaviours.
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Affiliation(s)
- Pål Kraft
- Department of Psychology, University of Oslo, Oslo, Norway
- Oslo New University College, Oslo, Norway
- *Correspondence: Pål Kraft,
| | - Brage Kraft
- Division of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Thomas Hagen
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Thomas Espeseth
- Department of Psychology, University of Oslo, Oslo, Norway
- Oslo New University College, Oslo, Norway
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Clouston SAP, Link BG. A retrospective on fundamental cause theory: State of the literature, and goals for the future. ANNUAL REVIEW OF SOCIOLOGY 2021; 47:131-156. [PMID: 34949900 PMCID: PMC8691558 DOI: 10.1146/annurev-soc-090320-094912] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Fundamental Cause Theory (FCT) was originally proposed to explain how socioeconomic inequalities in health emerged and persisted over time. The concept was that higher socioeconomic status helped some people to avoid risks and adopt protective strategies using flexible resources - knowledge, money, power, prestige and beneficial social connections. As a sociological theory, FCT addressed this issue by calling on social stratification, stigma, and racism as they affected medical treatments and health outcomes. The last comprehensive review was completed a decade ago. Since then, FCT has been tested, and new applications have extended central features. The current review consolidates key foci in the literature in order to guide future research in the field. Notable themes emerged around types of resources and their usage, approaches used to test the theory, and novel extensions. We conclude that after 25 years of use, there remain crucial questions to be addressed.
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Affiliation(s)
- Sean A. P. Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Bruce G. Link
- School of Public Policy and Department of Sociology, University of California at Riverside, Riverside, CA, USA
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10
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Deary IJ, Hill WD, Gale CR. Intelligence, health and death. Nat Hum Behav 2021; 5:416-430. [PMID: 33795857 DOI: 10.1038/s41562-021-01078-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/15/2021] [Indexed: 02/06/2023]
Abstract
The field of cognitive epidemiology studies the prospective associations between cognitive abilities and health outcomes. We review research in this field over the past decade and describe how our understanding of the association between intelligence and all-cause mortality has consolidated with the appearance of new, population-scale data. To try to understand the association better, we discuss how intelligence relates to specific causes of death, diseases/diagnoses and biomarkers of health through the adult life course. We examine the extent to which mortality and health associations with intelligence might be attributable to people's differences in education, other indicators of socioeconomic status, health literacy and adult environments and behaviours. Finally, we discuss whether genetic data provide new tools to understand parts of the intelligence-health associations. Social epidemiologists, differential psychologists and behavioural and statistical geneticists, among others, contribute to cognitive epidemiology; advances will occur by building on a common cross-disciplinary knowledge base.
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Affiliation(s)
- Ian J Deary
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK.
| | - W David Hill
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Catharine R Gale
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
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11
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Educational Disparities in COVID-19 Prevention in China: The Role of Contextual Danger, Perceived Risk, and Interventional Context. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073383. [PMID: 33805222 PMCID: PMC8036684 DOI: 10.3390/ijerph18073383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/22/2021] [Accepted: 03/05/2021] [Indexed: 12/15/2022]
Abstract
Despite the social disparities in COVID-19 infection, little is known about factors influencing social disparities in preventive behaviors during the pandemic. This study examined how educational disparities in mask-wearing, handwashing, and limiting public outings might be contingent upon three factors: contextual cue of danger, perceived risk of local outbreak, and interventional context with different levels of intensity (i.e, Wuhan vs. other areas). Data were obtained from a telephone survey of 3327 adults, who were recruited through a random-digit-dial method to be representative of all cell phone users in China. Interviews were conducted from 28 April to 26 May 2020. Stratified multiple regression models showed that educational disparities in all three behaviors were only consistently observed among people exposed to context cues of danger, with an enhanced sense of risk of a local outbreak, or in areas other than Wuhan. College education seems to make a difference in handwashing regardless of contextual cues of danger or perception of risk. The findings suggested that, in the process of an epidemic, emerging threats in one's immediate environment or raised awareness of risks are important conditions triggering educational disparities in prevention. However, effective public health interventions could potentially reduce such disparities.
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12
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Clouston SAP, Smith DM, Mukherjee S, Zhang Y, Hou W, Link BG, Richards M. Education and Cognitive Decline: An Integrative Analysis of Global Longitudinal Studies of Cognitive Aging. J Gerontol B Psychol Sci Soc Sci 2020; 75:e151-e160. [PMID: 31059564 PMCID: PMC7424268 DOI: 10.1093/geronb/gbz053] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The objective of this study was to examine the association between education and incidence of accelerated cognitive decline. METHODS Secondary analyses of data from the Health and Retirement Study (HRS), a nationally representative prospective cohort study of U.S. residents were conducted (N = 28,417). Cox proportional hazards survival models were layered on longitudinal mixed-effects modeling to jointly examine healthy cognitive aging and incidence of accelerated cognitive decline consistent with patterns seen in preclinical Alzheimer's disease and related dementias (ADRD). Replication analyses were completed on a database including 62,485 additional respondents from HRS sister studies. Life expectancy ratios (LER) and 95% confidence intervals (CIs) were reported. RESULTS This study replicated research showing that education was positively associated with cognition at baseline. Model fit improved using the survival method compared to random-slopes models alone. Analyses of HRS data revealed that higher education was associated with delayed onset of accelerated cognitive decline (LER = 1.031 95% CI = [1.013-1.015], p < 1E-06). Replication analyses using data from 14 countries identified similar results. CONCLUSIONS These results are consistent with cognitive reserve theory, suggesting that education reduces risk of ADRD-pattern cognitive decline. Follow-up work should seek to differentiate specific dementia types involved and consider potential mechanisms.
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Affiliation(s)
- Sean A P Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, New York
| | - Dylan M Smith
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, New York
| | - Soumyadeep Mukherjee
- Community and Public Health Promotion, Health and Physical Education Department, Rhode Island College, Providence, Rhode Island
| | - Yun Zhang
- Program in Public Health, Stony Brook University, New York
| | - Wei Hou
- Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, New York
| | - Bruce G Link
- Department of Sociology and School of Public Policy, University of California – Riverside, Riverside, California
| | - Marcus Richards
- Unit for Lifelong Health and Ageing at University College London, London, UK
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13
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Clouston SA, Acker J, Rubin MS, Chae DH, Link BG. Fundamental social causes of inequalities in colorectal cancer mortality: A study of behavioral and medical mechanisms. Heliyon 2020; 6:e03484. [PMID: 32190753 PMCID: PMC7068626 DOI: 10.1016/j.heliyon.2020.e03484] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/14/2019] [Accepted: 02/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fundamental cause theory posits that social conditions strongly influence the risk of health risks. This study identifies risk mechanisms that social conditions associated with socioeconomic status (SES) and race/ethnicity shape in the production of colorectal cancer (CRC) mortality. METHODS Two large datasets in the United States examining behavioral and medical preventive factors (N = 4.63-million people) were merged with population-level mortality data observing 761,100 CRC deaths among 3.31-billion person-years of observation to examine trends in CRC mortality from 1999-2012. Analyses examined the changing role of medical preventions and health behaviors in catalyzing SES and racial/ethnic inequalities in CRC mortality. RESULTS Lower SES as well as Black, Hispanic, Asian/Pacific Islander, and Native American race/ethnicity were associated with decreased access to age-appropriate screening and/or increased prevalence of behavioral risk factors. Analyses further revealed that SES and racial/ethnic inequalities were partially determined by differences in engagement in two preventive factors: use of colonoscopy, and participation in physical activity. DISCUSSION Social inequalities were not completely determined by behavioral risk factors. Nevertheless, a more equitable distribution of preventive medicines has the potential to reduce both the risk of, and social inequalities in, CRC mortality.
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Affiliation(s)
- Sean A.P. Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Julia Acker
- Family Community Medicine, University of California, San Francisco, CA, USA
| | - Marcie S. Rubin
- Section of Social and Behavioral Sciences, College of Dental Medicine, Columbia University, New York, NY, USA
| | - David H. Chae
- Center for Health Ecology and Equity Research, College of Human Sciences, Auburn University, Auburn, AL, USA
| | - Bruce G. Link
- Department of Sociology and School of Public Policy, University of California – Riverside, Riverside, CA, USA
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14
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Warren JR, Muller C, Hummer RA, Grodsky E, Humphries M. Which Aspects of Education Matter for Early Adult Mortality? Evidence from the High School and Beyond Cohort. SOCIUS : SOCIOLOGICAL RESEARCH FOR A DYNAMIC WORLD 2020; 6:10.1177/2378023120918082. [PMID: 33094163 PMCID: PMC7575125 DOI: 10.1177/2378023120918082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
What dimensions of education matter for people's chances of surviving young adulthood? Do cognitive skills, non-cognitive skills, course taking patterns, and school social contexts matter for young adult mortality, even net of educational attainment? We analyze data from High School & Beyond-a nationally representative cohort of ~25,000 high school students first interviewed in 1980. Many dimensions of education are associated with young adult mortality, and high school students' math course taking retain their associations with mortality net of educational attainment. Our work draws on theories and measures from sociological and educational research and enriches public health, economic, and demographic research on educational gradients in mortality that has almost exclusively relied on ideas of human capital accumulation and measures of degree attainment. Our findings also call on social and education researchers to engage together in research on the life-long consequences of educational processes, school structures, and inequalities in opportunities to learn.
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Affiliation(s)
- John Robert Warren
- Department of Sociology ~ Minnesota Population Center, University of Minnesota
| | - Chandra Muller
- Department of Sociology ~ Population Research Center, University of Texas
| | - Robert A Hummer
- Department of Sociology ~ Carolina Population Center, University of North Carolina
| | - Eric Grodsky
- Department of Sociology ~ Center for Demography and Ecology, University of Wisconsin
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15
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Abstract
A growing body of work identifies distinct health lifestyles among children, adolescents, and young adults and documents important social correlates. This study contributes to that line of research by identifying the health lifestyles of U.S. adults entering late middle age, assessing structural predictors of membership in different health lifestyles in this understudied age-group, and examining net associations between health lifestyles, chronic conditions, and physical health. The data come from the National Longitudinal Survey of Youth 1979 50+ Health Module. The analysis is based on respondents who answered the 50+ Health Module in 2008, 2010, 2012, or 2014 (N = 7,234). The results confirm similar relationships between health lifestyles and structural factors like class, gender, and race that prior studies observe and also reveal a unique pattern of associations between health lifestyle and health status because of diagnosed conditions that impact health behaviors in adulthood.
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Affiliation(s)
- William C Cockerham
- University of Alabama at Birmingham, AL and College of William & Mary, Williamsburg, VA, USA
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16
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Just-Østergaard E, Flensborg-Madsen T, Knop J, Sørensen HJ, Becker U, Mortensen EL. Intelligence in young adulthood and alcohol use disorders in a prospective cohort study of Danish men: the role of psychiatric disorders and parental psychiatric history. BMJ Open 2019; 9:e028997. [PMID: 31488478 PMCID: PMC6731796 DOI: 10.1136/bmjopen-2019-028997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The aims were to estimate the association between intelligence measured in young adulthood and risk of alcohol use disorders (AUD) in men and to investigate the potential modification of this association by psychiatric disorders, parental AUD and parental psychiatric disorders. DESIGN Prospective cohort study based on a linkage of intelligence test scores from draft board examinations and register data on AUD diagnoses during 36 years of follow-up. SETTING Denmark. PARTICIPANTS 3287 Danish men from the Copenhagen Perinatal Cohort (born 1959-1961) who appeared before the draft board at a mean age of 18.7 years. PRIMARY OUTCOME MEASURE First registration with AUD during follow-up was the primary outcome. Information on AUD was based on diagnoses retrieved from national hospital and outpatient treatment registers, defined according to the International Classification of Diseases. RESULTS 361 (11.0%) men were registered with AUD during follow-up. Low intelligence scores were associated with increased odds of AUD adjusting for parental AUD, parental psychiatric disorders, maternal smoking during pregnancy, birth weight, maternal age at birth, parity and childhood socioeconomic position (OR per SD decrease in intelligence=1.69, 95% CI 1.49 to 1.92). Separate analyses indicated significant interaction (p<0.001) between intelligence and psychiatric disorders. The adjusted OR per SD decrease in intelligence score was 2.04 (95% CI 1.67 to 2.49) in men without other psychiatric disorders whereas the OR was 1.21 (95% CI 1.01 to 1.46) in men with other psychiatric disorders. No interaction was found between intelligence and parental AUD or between intelligence and parental psychiatric disorders. CONCLUSIONS The association between intelligence in young adulthood and AUD is modified by other psychiatric disorders as low intelligence is primarily a risk factor for men without other psychiatric disorders. Future studies should take other psychiatric disorders into account when investigating associations between intelligence and AUD.
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Affiliation(s)
| | | | - Joachim Knop
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Ulrik Becker
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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17
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Agha G, Kezios K, Baccarelli AA, DuBois Bowman F, Rauh V, Susser ES, Cohn B, Cirillo P, Link BG, Factor-Litvak P, Staudinger UM. Cognition level and change in cognition during adolescence are associated with cognition in midlife. Ann Epidemiol 2019; 35:48-52.e2. [PMID: 31060895 DOI: 10.1016/j.annepidem.2019.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 02/01/2019] [Accepted: 03/06/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE Cognitive development during adolescence affects health long term. We investigated whether level of and change in language-based cognition during adolescence are associated with cognitive performance in midlife. METHODS Participants were enrolled in the Child Health and Development Study and followed during midlife (47-52 years). Adolescent cognition was measured with the Peabody Picture Vocabulary Test at ages 9-11 years (PPVT-9) and 15-17 years (PPVT-15). We examined PPVT-9, as well as a PPVT change score (derived using the standardized regression-based method) in relation to midlife cognition measures of Wechsler Test of Adult Reading, Verbal Fluency, and Digit Symbol tests. Linear regression models were adjusted for childhood socioeconomic status, age, sex, race, and midlife marital status, education, and occupational score. RESULTS In 357 participants (52.1% female, 25.6% African American), both PPVT-9 (β [95% confidence interval [CI] = 0.26 [0.18, 0.34]) and PPVT change score (β [95% CI] = 2.03 [1.27, 2.80]) were associated with Wechsler Test of Adult Reading at midlife. PPVT-9 was associated with midlife Verbal Fluency (β [95% CI] = 0.18 [0.10, 0.25]), whereas PPVT change score was not (β [95% CI] = -0.01 [-0.68, 0.67]). Neither PPVT-9 nor PPVT change score was associated with midlife Digit Symbol. CONCLUSIONS Both level of and change in language-based cognition during adolescence were associated with midlife vocabulary and language function, even after controlling for midlife occupation and education.
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Affiliation(s)
- Golareh Agha
- Columbia Aging Center, Columbia University Mailman School of Public Health, Columbia University, New York, NY.
| | - Katrina Kezios
- Columbia Aging Center, Columbia University Mailman School of Public Health, Columbia University, New York, NY
| | - Andrea A Baccarelli
- Columbia Aging Center, Columbia University Mailman School of Public Health, Columbia University, New York, NY
| | - F DuBois Bowman
- Columbia Aging Center, Columbia University Mailman School of Public Health, Columbia University, New York, NY
| | - Virginia Rauh
- Columbia Aging Center, Columbia University Mailman School of Public Health, Columbia University, New York, NY
| | - Ezra S Susser
- Columbia Aging Center, Columbia University Mailman School of Public Health, Columbia University, New York, NY
| | - Barbara Cohn
- Columbia Aging Center, Columbia University Mailman School of Public Health, Columbia University, New York, NY
| | - Piera Cirillo
- Columbia Aging Center, Columbia University Mailman School of Public Health, Columbia University, New York, NY
| | - Bruce G Link
- Columbia Aging Center, Columbia University Mailman School of Public Health, Columbia University, New York, NY
| | - Pam Factor-Litvak
- Columbia Aging Center, Columbia University Mailman School of Public Health, Columbia University, New York, NY
| | - Ursula M Staudinger
- Columbia Aging Center, Columbia University Mailman School of Public Health, Columbia University, New York, NY
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18
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Cheval B, Sieber S, Guessous I, Orsholits D, Courvoisier DS, Kliegel M, Stringhini S, Swinnen SP, Burton-Jeangros C, Cullati S, Boisgontier MP. Effect of Early- and Adult-Life Socioeconomic Circumstances on Physical Inactivity. Med Sci Sports Exerc 2018; 50:476-485. [PMID: 29112624 DOI: 10.1249/mss.0000000000001472] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE This study aimed to investigate the associations between early- and adult-life socioeconomic circumstances and physical inactivity (level and evolution) in aging using large-scale longitudinal data. METHODS This study used the Survey of Health Ageing and Retirement in Europe, a 10-yr population-based cohort study with repeated measurements in five waves, every 2 yr between 2004 and 2013. Self-reported physical inactivity (waves 1, 2, 4, and 5), household income (waves 1, 2, 4, and 5), educational attainment (wave of the first measurement occasion), and early-life socioeconomic circumstance (wave 3) were collected in 22,846 individuals 50 to 95 yr of age. RESULTS Risk of physical inactivity was increased for women with the most disadvantaged early-life socioeconomic circumstances (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.20-1.86). With aging, the risk of physical inactivity increased for both sexes and was strongest for those with the most disadvantaged early-life socioeconomic circumstances (OR, 1.04 (95% CI, 1.02-1.06) for women; OR, 1.02 (95% CI, 1.00-1.05) for men), with the former effect being more robust than the latter one. The association between early-life socioeconomic circumstances and physical inactivity was mediated by adult-life socioeconomic circumstances, with education being the strongest mediator. CONCLUSIONS Early-life socioeconomic circumstances predicted high levels of physical inactivity at older ages, but this effect was mediated by socioeconomic indicators in adult life. This finding has implications for public health policies, which should continue to promote education to reduce physical inactivity in people at older ages and to ensure optimal healthy aging trajectories, especially among women with disadvantaged early-life socioeconomic circumstances.
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Affiliation(s)
- Boris Cheval
- Swiss NCCR "LIVES-Overcoming Vulnerability: Life Course Perspectives," University of Geneva, Geneva, SWITZERLAND.,Swiss NCCR "LIVES-Overcoming Vulnerability: Life Course Perspectives," University of Geneva, Geneva, SWITZERLAND
| | - Stefan Sieber
- Swiss NCCR "LIVES-Overcoming Vulnerability: Life Course Perspectives," University of Geneva, Geneva, SWITZERLAND
| | - Idris Guessous
- Swiss NCCR "LIVES-Overcoming Vulnerability: Life Course Perspectives," University of Geneva, Geneva, SWITZERLAND.,Swiss NCCR "LIVES-Overcoming Vulnerability: Life Course Perspectives," University of Geneva, Geneva, SWITZERLAND.,Swiss NCCR "LIVES-Overcoming Vulnerability: Life Course Perspectives," University of Geneva, Geneva, SWITZERLAND.,Swiss NCCR "LIVES-Overcoming Vulnerability: Life Course Perspectives," University of Geneva, Geneva, SWITZERLAND
| | - Dan Orsholits
- Swiss NCCR "LIVES-Overcoming Vulnerability: Life Course Perspectives," University of Geneva, Geneva, SWITZERLAND
| | - Delphine S Courvoisier
- Swiss NCCR "LIVES-Overcoming Vulnerability: Life Course Perspectives," University of Geneva, Geneva, SWITZERLAND.,Swiss NCCR "LIVES-Overcoming Vulnerability: Life Course Perspectives," University of Geneva, Geneva, SWITZERLAND
| | - Matthias Kliegel
- Swiss NCCR "LIVES-Overcoming Vulnerability: Life Course Perspectives," University of Geneva, Geneva, SWITZERLAND.,Swiss NCCR "LIVES-Overcoming Vulnerability: Life Course Perspectives," University of Geneva, Geneva, SWITZERLAND
| | - Silvia Stringhini
- Swiss NCCR "LIVES-Overcoming Vulnerability: Life Course Perspectives," University of Geneva, Geneva, SWITZERLAND
| | - Stephan P Swinnen
- Swiss NCCR "LIVES-Overcoming Vulnerability: Life Course Perspectives," University of Geneva, Geneva, SWITZERLAND
| | - Claudine Burton-Jeangros
- Swiss NCCR "LIVES-Overcoming Vulnerability: Life Course Perspectives," University of Geneva, Geneva, SWITZERLAND
| | - Stéphane Cullati
- Swiss NCCR "LIVES-Overcoming Vulnerability: Life Course Perspectives," University of Geneva, Geneva, SWITZERLAND.,Swiss NCCR "LIVES-Overcoming Vulnerability: Life Course Perspectives," University of Geneva, Geneva, SWITZERLAND
| | - Matthieu P Boisgontier
- Swiss NCCR "LIVES-Overcoming Vulnerability: Life Course Perspectives," University of Geneva, Geneva, SWITZERLAND.,Swiss NCCR "LIVES-Overcoming Vulnerability: Life Course Perspectives," University of Geneva, Geneva, SWITZERLAND
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19
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Degerud E, Ystrom E, Tambs K, Ariansen I, Mørland J, Magnus P, Davey Smith G, Næss Ø. The interplay between cognitive ability, alcohol consumption, and health characteristics. Psychol Med 2018; 48:2011-2022. [PMID: 29239293 DOI: 10.1017/s0033291717003543] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Higher cognitive ability is associated with favourable health characteristics. The relation between ability and alcohol consumption, and their interplay with other health characteristics, is unclear. We aimed to assess the relationship between cognitive ability and alcohol consumption and to assess whether alcohol consumption relates differently to health characteristics across strata of ability. METHODS For 63 120 Norwegian males, data on cognitive ability in early adulthood were linked to midlife data on alcohol consumption frequency (times per month, 0-30) and other health characteristics, including cardiovascular risk factors and mental distress. Relations were assessed using linear regression and reported as unstandardised beta coefficients [95% confidence interval (CI)]. RESULTS The mean ± s.d. frequency of total alcohol consumption in the sample was 4.0 ± 3.8 times per month. In the low, medium, and high group of ability, the frequencies were 3.0 ± 3.3, 3.7 ± 3.5, and 4.7 ± 4.1, respectively. In the full sample, alcohol consumption was associated with physical activity, heart rate, fat mass, smoking, and mental distress. Most notably, each additional day of consumption was associated with a 0.54% (0.44-0.64) and 0.14% (0.09-0.18) increase in the probability of current smoking and mental distress, respectively. In each strata of ability (low, medium, high), estimates were 0.87% (0.57-1.17), 0.48% (0.31-0.66) and 0.49% (0.36-0.62) for current smoking, and 0.44% (0.28-0.60), 0.10% (0.02-0.18), and 0.09% (0.03-0.15) for mental distress, respectively. CONCLUSIONS Participants with low cognitive ability drink less frequently, but in this group, more frequent alcohol consumption is more strongly associated with adverse health characteristics.
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Affiliation(s)
- E Degerud
- Norwegian Institute of Public Health,P.O Box 4404,N-0403 Oslo,Norway
| | - E Ystrom
- Norwegian Institute of Public Health,P.O Box 4404,N-0403 Oslo,Norway
| | - K Tambs
- Norwegian Institute of Public Health,P.O Box 4404,N-0403 Oslo,Norway
| | - I Ariansen
- Norwegian Institute of Public Health,P.O Box 4404,N-0403 Oslo,Norway
| | - J Mørland
- Norwegian Institute of Public Health,P.O Box 4404,N-0403 Oslo,Norway
| | - P Magnus
- Norwegian Institute of Public Health,P.O Box 4404,N-0403 Oslo,Norway
| | - G Davey Smith
- MRC Integrative Epidemiology Unit,School of Social and Community Medicine,University of Bristol,Senate House,Tyndall Avenue,Bristol BS8 1TH,UK
| | - Ø Næss
- Norwegian Institute of Public Health,P.O Box 4404,N-0403 Oslo,Norway
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20
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Wraw C, Der G, Gale CR, Deary IJ. Intelligence in youth and health behaviours in middle age. INTELLIGENCE 2018; 69:71-86. [PMID: 30100645 PMCID: PMC6075942 DOI: 10.1016/j.intell.2018.04.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/30/2018] [Accepted: 04/29/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE We investigated the association between intelligence in youth and a range of health-related behaviours in middle age. METHOD Participants were the 5347 men and women who responded to the National Longitudinal Survey of Youth 1979 (NLSY-79) 2012 survey. IQ was recorded with the Armed Forces Qualification Test (AFQT) when participants were aged 15 to 23 years of age. Self-reports on exercise (moderate activity, vigorous activity, and strength training), dietary, smoking, drinking, and oral health behaviours were recorded when participants were in middle age (mean age = 51.7 years). A series of regression analyses tested for an association between IQ in youth and the different health related behaviours in middle age, while adjusting for childhood socio-economic status (SES) and adult SES. RESULTS Higher IQ in youth was significantly associated with the following behaviours that are beneficial to health: being more likely to be able to do moderate cardiovascular activity (Odds Ratio, 95% CI) (1.72, 1.35 to 2.20, p < .001) and strength training (1.61, 1.37 to 1.90, p < .001); being less likely to have had a sugary drink in the previous week (0.75, 0.71 to 0.80, p < .001); a lower likelihood of drinking alcohol heavily (0.67, 0.61 to 0.74, p < .001); being less likely to smoke (0.60, 0.56 to 0.65, p < .001); being more likely to floss (1.47, 1.35 to 1.59, p < .001); and being more likely to say they "often" read the nutritional information (1.20, 1.09 to 1.31, p < .001) and ingredients (1.24, 1.12 to 1.36, p < .001) on food packaging compared to always reading them. Higher IQ was also linked with dietary behaviours that may or may not be linked with poorer health outcomes (i.e. being more likely to have skipped a meal (1.10, 1.03 to 1.17, p = .005) and snacked between meals (1.37, 1.26 to 1.50, p < .001) in the previous week). An inverted u-shaped association was also found between IQ and the number of meals skipped per week. Higher IQ was also linked with behaviours that are known to be linked with poorer health (i.e. a higher likelihood of drinking alcohol compared to being abstinent from drinking alcohol (1.58, 1.47 to 1.69, p < .001)). A u-shaped association was found between IQ and the amount of alcohol consumed per week and an inverted u-shaped association was found between IQ and the number of cigarettes smoked a day. Across all outcomes, adjusting for childhood SES tended to attenuate the estimated effect size only slightly. Adjusting for adult SES led to more marked attenuation but statistical significance was maintained in most cases. CONCLUSION In the present study, a higher IQ in adolescence was associated with a number of healthier behaviours in middle age. In contrast to these results, a few associations were also identified between higher intelligence and behaviours that may or may not be linked with poor health (i.e. skipping meals and snacking between meals) and with behaviours that are known to be linked with poor health (i.e. drinking alcohol and the number of cigarettes smoked). To explore mechanisms of association, future studies could test for a range of health behaviours as potential mediators between IQ and morbidity or mortality in later life.
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Affiliation(s)
- Christina Wraw
- Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh, Scotland EH8 9JZ, UK
| | - Geoff Der
- MRC/CSO Social & Public Health Sciences Unit, 200 Renfield Street, University of Glasgow, Glasgow G2 3QB, UK
| | - Catharine R. Gale
- Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh, Scotland EH8 9JZ, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Ian J. Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh, Scotland EH8 9JZ, UK
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21
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Rawle MJ, Richards M, Davis D, Kuh D. The prevalence and determinants of polypharmacy at age 69: a British birth cohort study. BMC Geriatr 2018; 18:118. [PMID: 29769020 PMCID: PMC5956732 DOI: 10.1186/s12877-018-0795-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 04/30/2018] [Indexed: 12/02/2022] Open
Abstract
Background To describe the development of polypharmacy and its components in a British birth cohort in its seventh decade and to investigate socioeconomic and gender differences independent of disease burden. Methods Data from the MRC National Survey for Health and Development were analysed to determine the prevalence and composition of polypharmacy at age 69 and changes since ages 60 to 64. Multinomial regression was used to test associations between gender, education and occupational social class and total, cardiological and non-cardiological polypharmacy controlling for disease burden. Results At age 69, 22.8% of individuals were taking more than 5 medications. There was an increase in the use of 5 to 8 medications (+ 2.3%) and over 9 medications (+ 0.8%) between ages 60–64 and 69. The greatest increases were found for cardiovascular (+ 13.4%) and gastrointestinal medications (+ 7.3%). Men experienced greater cardiological polypharmacy, women greater non-cardiological polypharmacy. Higher levels of education were associated with lower polypharmacy independent of disease burden, with strongest effects seen for over five cardiological medications (RRR 0.3, 95% CI 0.2–0.5 p < 0.001 for advanced secondary qualifications compared with no qualification); there was no additional effect of social class. Conclusions Polypharmacy increased over the seventh decade. Those with lower levels of education had more polypharmacy (total, cardiological and non-cardiological), even allowing for disease burden. Further analysis of future outcomes resulting from polypharmacy should take into account educational and gender differences, in an effort to identify at-risk populations who could benefit from medication reviews.
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Affiliation(s)
- Mark James Rawle
- Medical Research Council Unit for Lifelong Health and Ageing at University College London, 33 Bedford Place, London, WC1B 5JU, England.
| | - Marcus Richards
- Medical Research Council Unit for Lifelong Health and Ageing at University College London, 33 Bedford Place, London, WC1B 5JU, England
| | - Daniel Davis
- Medical Research Council Unit for Lifelong Health and Ageing at University College London, 33 Bedford Place, London, WC1B 5JU, England
| | - Diana Kuh
- Medical Research Council Unit for Lifelong Health and Ageing at University College London, 33 Bedford Place, London, WC1B 5JU, England
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22
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Mawditt C, Sacker A, Britton A, Kelly Y, Cable N. Social influences on health-related behaviour clustering during adulthood in two British birth cohort studies. Prev Med 2018; 110:67-80. [PMID: 29428172 DOI: 10.1016/j.ypmed.2018.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/16/2018] [Accepted: 02/05/2018] [Indexed: 11/18/2022]
Abstract
Building upon evidence linking socio-economic position (SEP) in childhood and adulthood with health-related behaviours (HRB) in adulthood, we examined how pre-adolescent SEP predicted membership of three HRB clusters: "Risky", "Moderate Smokers" and "Mainstream" (the latter pattern consisting of more beneficial HRBs), that were detected in our previous work. Data were taken from two British cohorts (born in 1958 and 1970) in pre-adolescence (age 11 and 10, respectively) and adulthood (age 33 and 34). SEP constructs in pre-adolescence and adulthood were derived through Confirmatory Factor Analysis. Conceptualised paths from pre-adolescent SEP to HRB cluster membership via adult SEP in our path models were tested for statistical significance separately by gender and cohort. Adult SEP mediated the path between pre-adolescent SEP and adult HRB clusters. More disadvantaged SEP in pre-adolescence predicted more disadvantaged SEP in adulthood which was associated with membership of the "Risky" and "Moderate Smokers" clusters compared to the "Mainstream" cluster. For example, large positive indirect effects between pre-adolescent SEP and adult HRB via adult SEP were present (coefficient 1958 Women = 0.39; 1970 Women = 0.36, 1958 Men = 0.51; 1970 Men = 0.39; p < 0.01) when comparing "Risky" and "Mainstream" cluster membership. Amongst men we found a small significant direct association (p < 0.001) between pre-adolescent SEP and HRB cluster membership. Our findings suggest that associations between adult SEP and HRBs are not likely to be pre-determined by earlier social circumstances, providing optimism for interventions relevant to reducing social gradients in HRBs. Observing consistent findings across the cohorts implies the social patterning of adult lifestyles may persist across time.
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Affiliation(s)
- Claire Mawditt
- International Centre for Lifecourse Studies in Society and Health, Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom.
| | - Amanda Sacker
- International Centre for Lifecourse Studies in Society and Health, Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom.
| | - Annie Britton
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom.
| | - Yvonne Kelly
- International Centre for Lifecourse Studies in Society and Health, Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom.
| | - Noriko Cable
- International Centre for Lifecourse Studies in Society and Health, Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom.
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Childhood disadvantage, education, and psychological distress in adulthood: A three-wave population-based study. J Affect Disord 2018; 229:206-212. [PMID: 29324368 DOI: 10.1016/j.jad.2017.12.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 12/14/2017] [Accepted: 12/27/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND We assessed the mediating role of education in the association between childhood disadvantage and psychological distress in adulthood using longitudinal data collected in three waves, from 1994 to 2008, in the framework of the Tromsø Study (N = 4530), a cohort that is representative of men and women from Tromsø. METHODS Education was measured at a mean age of 54.7 years, and psychological distress in adulthood was measured at a mean age of 61.7 years. Ordinary least square regression analysis was used to assess the associations between childhood disadvantage, education, and psychological distress in adulthood. The indirect effects and the proportion (%) of indirect effects of childhood disadvantage (via education) on psychological distress in adulthood were assessed by mediation analysis. RESULTS Childhood disadvantage was associated with lower education and higher psychological distress in adulthood (p < 0.05). Lower education was associated with a higher psychological distress in adulthood (p < 0.05). A minor proportion (7.51%, p < 0.05) of the association between childhood disadvantage and psychological distress in adulthood was mediated by education. LIMITATIONS Childhood disadvantages were measured retrospectively. CONCLUSION The association between childhood disadvantage and psychological distress in adulthood is primarily independent of education.
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Carroll JM, Muller C, Grodsky E, Warren JR. Tracking Health Inequalities from High School to Midlife. SOCIAL FORCES; A SCIENTIFIC MEDIUM OF SOCIAL STUDY AND INTERPRETATION 2017; 96:591-628. [PMID: 29379220 PMCID: PMC5786152 DOI: 10.1093/sf/sox065] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Educational gradients in health status, morbidity, and mortality are well established, but which aspects of schooling produce those gradients is only partially understood. We draw on newly available data from the midlife follow-up of the High School and Beyond sophomore cohort to analyze the relationship between students' level of coursework in high school and their long-term health outcomes. We additionally evaluate the mediating roles of skill development, postsecondary attendance and degree attainment, and occupational characteristics. We find that students who took a medium- to high-level course of study in high school have better self-reported health and physical functioning in midlife, even net of family background, adolescent health, baseline skills, and school characteristics. The association partially operates through pathways into postsecondary education. Our findings have implications for both educational policy and research on the educational gradient in health.
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A Social History of Disease: Contextualizing the Rise and Fall of Social Inequalities in Cause-Specific Mortality. Demography 2017; 53:1631-1656. [PMID: 27531503 DOI: 10.1007/s13524-016-0495-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Fundamental cause theory posits that social inequalities in health arise because of unequal access to flexible resources, including knowledge, money, power, prestige, and beneficial social connections, which allow people to avoid risk factors and adopt protective factors relevant in a particular place. In this study, we posit that diseases should also be put into temporal context. We characterize diseases as transitioning through four stages at a given time: (1) natural mortality, characterized by no knowledge about risk factors, preventions, or treatments for a disease in a population; (2) producing inequalities, characterized by unequal diffusion of innovations; (3) reducing inequalities, characterized by increased access to health knowledge; and (4) reduced mortality/disease elimination, characterized by widely available prevention and effective treatment. For illustration, we pair an ideal-types analysis with mortality data to explore hypothesized incidence rates of diseases. Although social inequalities exist in incidence rates of many diseases, the cause, extent, and direction of inequalities change systematically in relation to human intervention. This article highlights opportunities for further development, specifically highlighting the role of stage duration in maintaining social inequalities in cause-specific mortality.
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Andersson MA, Gadarian SK, Almeling R. Does educational attainment shape reactions to genetic risk for Alzheimer's disease? Results from a national survey experiment. Soc Sci Med 2017; 180:101-105. [PMID: 28334652 DOI: 10.1016/j.socscimed.2017.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 11/30/2022]
Abstract
While higher education is associated with healthy lifestyles and health literacy, it remains unclear whether education shapes reactions to varying levels of genetic risk for Alzheimer's disease (AD). In this study, participants (N = 701) in the National Genetic Risk Survey Experiment (NGRISE) received a hypothetical genetic risk assessment for AD (ranging from 20 to 80% lifetime risk) and then completed items on their cognitive (perceived threat to health), emotional (general negative affect), and anticipated behavioral (seek information, improve health behaviors, engage in public or private civic action) reactions to this risk. Individuals with a college education showed reactions to increasing genetic risk approximately twice or several times as strong relative to those of individuals with lower (high school, HS) education. In fact, behavioral reactions do not significantly increase with AD risk among those with HS education. Some educational differences in risk response widen at older ages.
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Link BG, Susser ES, Factor-Litvak P, March D, Kezios KL, Lovasi GS, Rundle AG, Suglia SF, Fader KM, Andrews HF, Johnson E, Cirillo PM, Cohn BA. Disparities in self-rated health across generations and through the life course. Soc Sci Med 2016; 174:17-25. [PMID: 27987434 DOI: 10.1016/j.socscimed.2016.11.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 11/03/2016] [Accepted: 11/24/2016] [Indexed: 01/19/2023]
Abstract
Extensive evidence leads us to expect that health disparities by race and socioeconomic status found in one generation might be reproduced in the next. To the extent that this occurs it is important to assess life course processes responsible for the reproduction. Prospective evidence concerning such life course processes is hard to come by as it requires long-term follow-up of individuals from childhood through adult life. We present data from the Child Health and Development Disparities study that provides evidence relevant to this issue with respect to self-rated health. Mothers and offspring recruited in California's Bay Area between 1959 and 1967 were assessed during pregnancy with follow-up exams of offspring along with in-person interviews with mothers (at offspring ages 5, 9-11, 15-17) and offspring (at ages 15-17, ∼50). Available data allow us to assess the importance of three potential life course pathways in the reproduction of inequalities in self-rated health - socioeconomic pathways, cognitive pathways and pathways involving emerging health itself. As expected we found that race and SES disparities in SRH are reproduced across generations. They are evident in mothers, not strong or significant in offspring at 15-17, but present once again in offspring at age ∼50. Concerning potential pathways, we found that indicators of child health were related to adult SRH and played some role in accounting for race but not SES disparities in adult SRH. Cognitive abilities were unrelated to adult SRH with childhood SES controlled. Childhood SES was associated with adult SRH independent of other childhood factors and is reduced to non-significance only when offspring college attainment is controlled. Race and SES disparities in self-reported health in one generation are re-expressed in the next with strongest support for SES pathways in this transmission.
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Affiliation(s)
- Bruce G Link
- University of California Riverside, United States.
| | - Ezra S Susser
- Columbia University, United States; New York State Psychiatric Institute, United States
| | | | | | | | | | | | | | | | | | - Eileen Johnson
- Child Health and Development Studies, Public Health Institute, Oakland, California, United States
| | - Piera M Cirillo
- Child Health and Development Studies, Public Health Institute, Oakland, California, United States
| | - Barbara A Cohn
- Child Health and Development Studies, Public Health Institute, Oakland, California, United States
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Clouston SA, Glymour MM, Terrera GM. Educational inequalities in aging-related declines in fluid cognition and the onset of cognitive pathology. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2015; 1:303-310. [PMID: 26309906 PMCID: PMC4542007 DOI: 10.1016/j.dadm.2015.06.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Education has been robustly associated with cognitive reserve and dementia, but not with the rate of cognitive aging, resulting in some confusion about the mechanisms of cognitive aging. This study uses longitudinal data to differentiate between trajectories indicative of healthy versus pathological cognitive aging. METHODS Participants included 9,401 Health and Retirement Study respondents aged 55 and older who completed cognitive testing regularly over 17.3 years until most recently in 2012. Individual-specific random change-point modeling was used to identify age of incident pathological decline; acceleration is interpreted as indicating likely onset of pathological decline when it is significant and negative. RESULTS These methods detect incident dementia diagnoses with specificity/sensitivity of 89.3%/44.3%, 5.6 years prior to diagnosis. Each year of education was associated with 0.09 (95% CI, 0.087-0.096; P<0.001) standard deviation higher baseline cognition and delayed onset of cognitive pathology (HR, 0.98; 95% CI, 0.96-0.99; P=0.006). CONCLUSION Longitudinal random change-point modeling was able to reliably identify incident dementia. Accounting for incident cognitive pathology, we find that education predicts cognitive capability and delayed onset pathological declines.
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Affiliation(s)
- Sean A.P. Clouston
- Program in Public Health and Department of Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - M. Maria Glymour
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
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