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Abstract
INTRODUCTION
Birth in the Southern United States is associated with poorer late‐life cognitive health, especially among Black Americans, yet the role of school segregation is unclear.
METHODS
Utilizing decomposition methods, we estimated the total effect, natural direct effect (NDE), and natural indirect effect (NIE) of Southern birth on domain‐specific cognition among 727 older Black adults, adjusting for early‐life covariates. We also estimated the proportion of the total effect mediated by self‐reported segregated school attendance.
RESULTS
Southern birth was associated with lower late‐life executive function and semantic memory; estimates were negative but not significant for verbal episodic memory. The direct effect of Southern birth was negative but not significant for all domains. Attending a segregated school mediated 35% and 49% of the total association between Southern birth and executive function (NIE: −0.07, 95% confidence interval [CI]: [−0.18, 0.02]) and semantic memory (NIE:−0.17, 95% CI: [−0.29, −0.06]).
DISCUSSION
School segregation may partially drive geographic inequities in late‐life cognition in the United States.
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Details
1 Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
2 Alzheimer's Disease Center, University of California, Davis, Sacramento, California, USA, Department of Public Health Sciences, University of California Davis, Davis, California, USA, Division of Research, Kaiser Permanente Northern California, Pleasanton, California, USA
3 Department of Public Health Sciences, University of California Davis, Davis, California, USA
4 School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
5 Department of Medicine, University of California San Francisco, San Francisco, California, USA
6 Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
7 Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA, Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
8 Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA, Division of Research, Kaiser Permanente Northern California, Pleasanton, California, USA