Diverging cognitive benefits from education between rural and urban middle-aged and older adults in the USA.

Background: Subjective cognitive decline (SCD) is defined as self-reported increase in confusion or memory loss. There is limited research on the interplay between rural-urban residence and education on SCD.

Aims: Examine rural-urban differences in SCD, and whether education moderates this relationship.

Method: Respondents aged ≥45 years were queried about SCD in the 2022 Behavioral Risk Factor Surveillance System data, creating a sample size of 63 890. A logistic regression analysed the association between rural-urban residence and SCD, and moderation was tested by an interaction with education.

Results: SCD was more common among rural (12.0%) compared with urban (10.7%) residents. Rural residence was associated with 9% significantly higher odds of SCD compared with urban residence after adjusting for sociodemographic and health covariates (adjusted odds ratio (aOR) = 1.09, P = 0.01). There was a negative relationship between education level and SCD, including the association of college degree with 15% lower odds of SCD compared with less than high school degree (aOR = 0.85, P < 0.01). Education was a significant moderator, with higher education associated with lower odds of SCD for urban, but not rural, residents.

Conclusions: Rural setting and lower education were associated with higher odds of SCD, but higher education was protective for only urban residents. These results indicate that higher education may be a gateway for more opportunities and resources in urban settings, with cascading impacts on cognition. Future research should examine reasons for the diverging cognitive benefits from education depending on rural-urban residence.