老年人社会经济地位和认知功能的多层次和多维特征:IGNITE研究的横断面分析

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES
Jermon A. Drake , Lu Wan , Chaeryon Kang , Peter J. Gianaros , Patricio Solis-Urra , Haiqing Huang , Rebecca Reed , Charles H. Hillman , Eric D. Vidoni , Jeffrey M. Burns , Arthur F. Kramer , Edward McAuley , George Grove , Kirk I. Erickson , Lauren E. Oberlin
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引用次数: 0

摘要

背景:较低的社会经济地位(SES)与认知能力下降和痴呆的风险增加有关,但依赖单一的社会经济地位指标限制了对这些关系的理解。我们在一个大型社区老年人样本中,同时在个体和区域水平上研究了与不同认知过程相关的多个SES特征。方法在美国三个地点(波士顿、匹兹堡、堪萨斯城)收集的数据包括一个全面的认知评估,包括情景记忆、执行功能、处理速度、工作记忆和视觉空间能力。多重SES测量包括区域水平(区域剥夺指数),主观和客观SES。我们从收入、储蓄、债务调整储蓄和金融稳定性的测量中产生了一个新的客观的SES潜在因素,使用全信息最大可能性来解决缺失数据,并在多变量回归模型中检查了SES指标与每个认知领域作为结果变量的横断面关联。本研究纳入648名认知功能正常的老年人(69.88(3.75)岁;71%的女性)。个体水平目标SES(处理速度,β[95%可信区间(CI)] = 0.225 [0.152-0.299];执行功能,0.210 [0.137-0.283];情景记忆,0.113 [0.040-0.186];工作记忆,0.200 [0.129-0.271];视觉空间加工,0.165[0.093-0.238])和主观SES(加工速度,β [95% CI] = 0.148 [0.077-0.219];执行功能,0.138 [0.067-0.208];情景记忆,0.020[−0.051 ~ 0.091];工作记忆,0.128 [0.059-0.197];视觉空间处理(visual spatial processing, 0.094[0.023-0.164])在检测认知缺陷方面优于区域水平SES,并且在认知领域表现较差存在广泛关联。平均而言,处于最低客观社会地位四分位数的个体比处于最高社会地位四分位数的个体在各领域的表现低0.22至0.58个标准差(处理速度,两两调整平均差异[95% CI] = 0.580 [0.304-0.856];执行功能,0.556 [0.282-0.829];情景记忆,0.223[−0.054 ~ 0.499];工作记忆,0.516 [0.248-0.784];视觉空间处理,0.434[0.161-0.706])。一种新的客观SES组合显示出与认知的强大关联,超越了传统的SES测量。所有的发现都是随机假设的缺失。解释客观社会经济地位的标准测量可能低估了社会经济不平等的广泛认知负担。将多种财务指标纳入未来的研究可能会改善对老年人社会经济条件对公共卫生影响的估计。美国国立卫生研究院(R01AG053952)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Multilevel and multidimensional features of socioeconomic status and cognitive function in older adulthood: a cross-sectional analysis of the IGNITE study

Background

Lower socioeconomic status (SES) is associated with increased risk of cognitive decline and dementia, yet reliance on singular indicators of SES limits understanding of these relationships. We examined multiple SES characteristics at the individual and area-levels simultaneously in association with diverse cognitive processes in a large, community-dwelling older adult sample.

Methods

Data collected at three United States sites (Boston, Pittsburgh, Kansas City) included a comprehensive cognitive assessment comprising measures of episodic memory, executive function, processing speed, working memory, and visuospatial abilities. Multiple SES measures were obtained including area-level (Area Deprivation Index), subjective, and objective SES. We generated a novel objective SES latent factor from measures of income, savings, debt-adjusted savings, and financial stability using full information maximum likelihood to address missing data, and examined cross–sectional associations of SES indicators with each cognitive domain as outcome variables in multivariable regression models.

Findings

This study included 648 cognitively unimpaired older adults (69.88 (3.75) years; 71% female). Individual-level objective SES (processing speed, β [95% confidence interval (CI)] = 0.225 [0.152–0.299]; executive function, 0.210 [0.137–0.283]; episodic memory, 0.113 [0.040–0.186]; working memory, 0.200 [0.129–0.271]; visuospatial processing, 0.165 [0.093–0.238]) and subjective SES (processing speed, β [95% CI] = 0.148 [0.077–0.219]; executive function, 0.138 [0.067–0.208]; episodic memory, 0.020 [−0.051 to 0.091]; working memory, 0.128 [0.059–0.197]; visuospatial processing, 0.094 [0.023–0.164]) outperformed area-level SES in detecting cognitive deficits, and demonstrated widespread associations with poorer performance across cognitive domains. On average, individuals categorized into the lowest objective SES quartile performed between 0.22 and 0.58 standard deviations lower than those in the highest quartile across domains (processing speed, pairwise adjusted mean difference [95% CI] = 0.580 [0.304–0.856]; executive function, 0.556 [0.282–0.829]; episodic memory, 0.223 [−0.054 to 0.499]; working memory, 0.516 [0.248–0.784]; visuospatial processing, 0.434 [0.161–0.706]). A novel objective SES composite showed robust associations with cognition above and beyond traditional SES measures. All findings are subject to missing at random assumptions.

Interpretation

Standard measures of objective SES may underestimate the broad cognitive burden of socioeconomic inequity. Integrating multiple financial indicators into future studies may improve estimation of the public health impact of socioeconomic conditions in older adulthood.

Funding

National Institutes of Health (R01AG053952).
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来源期刊
CiteScore
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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.
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