{"title":"与土著、西班牙裔、黑人和白人老年人认知健康轨迹相关的可改变因素:以土著为重点的健康和退休研究的探索性纵向面板分析","authors":"Cliff Whetung , Ernest Gonzales","doi":"10.1016/j.lana.2025.101207","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Despite elevated dementia risk, cognitive health among Indigenous older adults remains understudied. This study explored how modifiable factors were associated with cognitive health among Indigenous, Black, Hispanic, and White older adults.</div></div><div><h3>Methods</h3><div>Using longitudinal panel data from the Health and Retirement Study (2006–2020, N = 27,327), we estimated mixed effect growth curve models to examine associations between modifiable factors and total cognitive function.</div></div><div><h3>Findings</h3><div>This diverse sample of Indigenous (1.65%), Black (11.43%), Hispanic (9.85%), and White (77.07%) older adults had a mean age of 61 (SD = 9.66) and was 52% female. Despite being younger on average (M = 59), 3% of Indigenous respondents reported memory-related diagnoses three times the overall sample rate. Linear mixed-effect growth curve analysis revealed that Indigenous and Black older adults had similar cognitive trajectories. A college education was a protective factor for initial cognitive function (<em>b</em><sub>0</sub> = 3.09, 95% CI: 2.91, 3.27) and over time (<em>b</em> = 0.24, 95% CI: 0.15, 0.33) across ethnicity. Formal (<em>b</em> = 0.21, 95% CI: 0.15, 0.27) and informal (<em>b</em> = 0.26, 95% CI: 0.20, 0.32) volunteering were associated with slower rates of cognitive decline relative to non-volunteers, though these effects may partly reflect socioeconomic status. Among Indigenous older adults, higher education, volunteering, and fewer depressive symptoms were linked to better cognitive outcomes.</div></div><div><h3>Interpretation</h3><div>Despite high levels of resource deprivation, Indigenous older adults demonstrate resilience that supports cognitive health. Expanding access to education and volunteering in later life through targeted social policy may enhance cognitive outcomes in Indigenous communities for generations.</div></div><div><h3>Funding</h3><div>This research was supported by the <span>National Institute on Aging</span> (R36AG078781).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"50 ","pages":"Article 101207"},"PeriodicalIF":7.0000,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Modifiable factors associated with cognitive health trajectories among Indigenous, Hispanic, Black, and White older adults: an exploratory longitudinal panel analysis of the health and retirement study with a focus on Indigenous peoples\",\"authors\":\"Cliff Whetung , Ernest Gonzales\",\"doi\":\"10.1016/j.lana.2025.101207\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Despite elevated dementia risk, cognitive health among Indigenous older adults remains understudied. This study explored how modifiable factors were associated with cognitive health among Indigenous, Black, Hispanic, and White older adults.</div></div><div><h3>Methods</h3><div>Using longitudinal panel data from the Health and Retirement Study (2006–2020, N = 27,327), we estimated mixed effect growth curve models to examine associations between modifiable factors and total cognitive function.</div></div><div><h3>Findings</h3><div>This diverse sample of Indigenous (1.65%), Black (11.43%), Hispanic (9.85%), and White (77.07%) older adults had a mean age of 61 (SD = 9.66) and was 52% female. Despite being younger on average (M = 59), 3% of Indigenous respondents reported memory-related diagnoses three times the overall sample rate. Linear mixed-effect growth curve analysis revealed that Indigenous and Black older adults had similar cognitive trajectories. A college education was a protective factor for initial cognitive function (<em>b</em><sub>0</sub> = 3.09, 95% CI: 2.91, 3.27) and over time (<em>b</em> = 0.24, 95% CI: 0.15, 0.33) across ethnicity. Formal (<em>b</em> = 0.21, 95% CI: 0.15, 0.27) and informal (<em>b</em> = 0.26, 95% CI: 0.20, 0.32) volunteering were associated with slower rates of cognitive decline relative to non-volunteers, though these effects may partly reflect socioeconomic status. Among Indigenous older adults, higher education, volunteering, and fewer depressive symptoms were linked to better cognitive outcomes.</div></div><div><h3>Interpretation</h3><div>Despite high levels of resource deprivation, Indigenous older adults demonstrate resilience that supports cognitive health. Expanding access to education and volunteering in later life through targeted social policy may enhance cognitive outcomes in Indigenous communities for generations.</div></div><div><h3>Funding</h3><div>This research was supported by the <span>National Institute on Aging</span> (R36AG078781).</div></div>\",\"PeriodicalId\":29783,\"journal\":{\"name\":\"Lancet Regional Health-Americas\",\"volume\":\"50 \",\"pages\":\"Article 101207\"},\"PeriodicalIF\":7.0000,\"publicationDate\":\"2025-08-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Lancet Regional Health-Americas\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2667193X25002170\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lancet Regional Health-Americas","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2667193X25002170","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
Modifiable factors associated with cognitive health trajectories among Indigenous, Hispanic, Black, and White older adults: an exploratory longitudinal panel analysis of the health and retirement study with a focus on Indigenous peoples
Background
Despite elevated dementia risk, cognitive health among Indigenous older adults remains understudied. This study explored how modifiable factors were associated with cognitive health among Indigenous, Black, Hispanic, and White older adults.
Methods
Using longitudinal panel data from the Health and Retirement Study (2006–2020, N = 27,327), we estimated mixed effect growth curve models to examine associations between modifiable factors and total cognitive function.
Findings
This diverse sample of Indigenous (1.65%), Black (11.43%), Hispanic (9.85%), and White (77.07%) older adults had a mean age of 61 (SD = 9.66) and was 52% female. Despite being younger on average (M = 59), 3% of Indigenous respondents reported memory-related diagnoses three times the overall sample rate. Linear mixed-effect growth curve analysis revealed that Indigenous and Black older adults had similar cognitive trajectories. A college education was a protective factor for initial cognitive function (b0 = 3.09, 95% CI: 2.91, 3.27) and over time (b = 0.24, 95% CI: 0.15, 0.33) across ethnicity. Formal (b = 0.21, 95% CI: 0.15, 0.27) and informal (b = 0.26, 95% CI: 0.20, 0.32) volunteering were associated with slower rates of cognitive decline relative to non-volunteers, though these effects may partly reflect socioeconomic status. Among Indigenous older adults, higher education, volunteering, and fewer depressive symptoms were linked to better cognitive outcomes.
Interpretation
Despite high levels of resource deprivation, Indigenous older adults demonstrate resilience that supports cognitive health. Expanding access to education and volunteering in later life through targeted social policy may enhance cognitive outcomes in Indigenous communities for generations.
Funding
This research was supported by the National Institute on Aging (R36AG078781).
期刊介绍:
The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.