The role of education in the association between race/ethnicity/nativity, cognitive impairment, and dementia among older adults in the United States

Headnote

Abstract

BACKGROUND

Older Black and Hispanic adults are more likely to be cognitively impaired than older White adults. Disadvantages in educational achievement for minority and immigrant populations may contribute to disparities in cognitive impairment.

OBJECTIVE

Examine the role of education in racial/ethnic and nativity differences in cognitive impairment/no dementia (CIND) and dementia among older US adults.

METHODS

Data comes from the 2012 Health and Retirement Study. A total of 19,099 participants aged >50 were included in the analysis. Participants were categorized as having normal cognition, CIND, or dementia based on the Telephone Interview for Cognitive Status (TICS) or questions from a proxy interview. We document age and educational differences in cognitive status among White, Black, US-born Hispanic, and foreign-born Hispanic adults by sex. Logistic regression is used to quantify the association between race/ethnicity/nativity, education, and cognitive status by sex.

RESULTS

Among women, foreign-born Hispanics have higher odds of CIND and dementia than Whites. For men, Blacks have higher odds for CIND and dementia compared to Whites. The higher odds for CIND and dementia across race/ethnic and nativity groups was reduced after controlling for years of education but remained statistically significant for older Black and US-born Hispanic adults. Controlling for education reduces the odds for CIND (women and men) and dementia (men) among foreign-born Hispanics to nonsignificance.

CONTRIBUTION

These results highlight the importance of education in CIND and dementia, particularly among foreign-born Hispanics. Addressing inequalities in education can contribute to reducing racial/ethnic/nativity disparities in CIND and dementia for older adults.

1.Introduction

Extensive research has been conducted on racial and ethnic disparities in cognitive functioning in the United States. These findings indicate that older non-Hispanic Blacks (hereafter, Blacks) and Hispanics have lower cognitive performance than non-Hispanic Whites (hereafter, Whites) on measures of memory (Masel and Peek 2009), executive functioning (Early et al. 2013), and global cognition (Díaz-Venegas et al. 2016). Blacks and Hispanics are also more likely to have cognitive impairment, and spend a larger proportion of their remaining years after age 50 with cognitive impairment/no dementia (CIND) and dementia than Whites (Alzheimer's Association 2010; Garcia et al. 2017a; Langa et al. 2017). These racial/ethnic disparities in cognitive functioning have been attributed to several factors including a higher prevalence of chronic health conditions associated with an...