The Role of Early-Life Educational Quality and Literacy in Explaining Racial Disparities in Cognition in Late Life

Sisco, Shannon; Gross, Alden L.; Shih, Regina A.; Sachs, Bonnie C.; Glymour, M. Maria; Bangen, Katherine J.; Benitez, Andreana; Skinner, Jeannine S.; Schneider, Brooke C.; Manly, Jennifer J.

doi:10.1093/geronb/gbt133

Cited by 209 publications

(216 citation statements)

References 46 publications

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“…Given these extremely poor social conditions, it is perhaps surprising that, at first glance, our results are consistent with those from predominantly higher-income countries confirming the importance of education for cognitive performance in later life (Araújo et al, 2014; Clouston et al, 2012; Fors et al, 2009; Glymour et al, 2012; Horvat et al, 2014; Lee et al, 2014; Onadja et al, 2013; Scazufca et al, 2008; Sisco et al, 2015). In the US population aged ≥50 years, each additional year of education attained was associated with a 0.09 SD increase in word recall scores, similar to that observed here of a 0.09 SD increase (Glymour et al, 2008).…”

Section: Discussionsupporting

confidence: 84%

“…Existing life course research from high-, middle-, and low-income contexts consistently demonstrates that early-life socioeconomic conditions and educational attainment are associated with cognitive function in later-life (Araújo et al, 2014; Chen, 2016; Clouston et al, 2012; Fors et al, 2009; Glymour et al, 2012, 2008; Horvat et al, 2014; Hurst et al, 2013; Kaplan et al, 2001; Lee et al, 2014; McEniry, 2013; Melrose et al, 2015; Onadja et al, 2013; Scazufca et al, 2008; Sisco et al, 2015). However, little research has been conducted in sub-Saharan African settings, such as in South Africa, where opportunities for social mobility were restricted by the state for the majority of the country’s population.…”

Section: Introductionmentioning

confidence: 99%

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Childhood deprivation and later-life cognitive function in a population-based study of older rural South Africans

Kobayashi¹,

Glymour

Kahn

et al. 2017

Social Science & Medicine

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Rationale Little research has evaluated the life course drivers of cognitive aging in South Africa. Objectives We investigated the relationships of self-rated childhood health and father’s occupation during childhood with later-life cognitive function score and whether educational attainment mediated these relationships among older South Africans living in a former region of Apartheid-era racial segregation. Methods Data were from baseline assessments of “Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community” (HAALSI), a population-based study of 5059 men and women aged ≥40 years in 2015 in rural Agincourt sub-district, South Africa. Childhood health, father’s occupation during childhood, and years of education were self-reported in study interviews. Cognitive measures assessed time orientation, numeracy, and word recall, which were included in a z-standardized latent cognitive function score variable. Linear regression models adjusted for age, sex, and country of birth were used to estimate the total and direct effects of each childhood risk factor, and the indirect effects mediated by years of education. Results Poor childhood health predicted lower cognitive scores (total effect = −0.28; 95% CI = −0.35, −0.21, versus good); this effect was not mediated by educational attainment. Having a father in a professional job during childhood, while rare (3% of sample), predicted better cognitive scores (total effect = 0.25; 95% CI = 0.10, 0.40, versus unskilled manual labor, 29% of sample). Half of this effect was mediated by educational attainment. Education was linearly associated with later-life cognitive function score (0.09; 95% CI = 0.09, 0.10 per year achieved). Conclusion In this post-Apartheid, rural South African context, older adults with poor self-reported childhood health or whose father worked in unskilled manual labor had relatively poor cognitive outcomes. Educational attainment strongly predicted cognitive outcomes, and appeared to be, in part, a mechanism of social stratification in later-life cognitive health in this context.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Childhood deprivation and later-life cognitive function in a population-based study of older rural South Africans

Kobayashi¹,

Glymour

Kahn

et al. 2017

Social Science & Medicine

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“…Indeed, literacy in later life (as a measure of educational quality) is a stronger predictor of cognitive performance in older individuals than years of education [62]. In addition, certain items on the MoCA are likely to be influenced by education [43], for instance, clock drawing, phonemic verbal fluency, and verbal abstraction [59].…”

Section: Discussionmentioning

confidence: 99%

Cross-Cultural Applicability of the Montreal Cognitive Assessment (MoCA): A Systematic Review

O’Driscoll

Shaikh

2017

JAD

148

121

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The MoCA is widely used to screen for mild cognitive impairment. While there are many available versions, the cross cultural validity of the assessment has not been explored sufficiently.We aimed to interrogate the validity of the MoCA in a cross-cultural context: in differentiating mild cognitive impairment (MCI) from normal controls (NC); and identifying cut-offs and adjustments for age and education where possible. This review sourced a wide range of studies including case-control studies. In addition, we report findings for differentiating dementias from NC and MCI from dementias, however, these were not considered to be an appropriate use of the MoCA.The subject of the review assumes heterogeneity and therefore meta-analysis/es was not conducted. Quality ratings, forest plots of validated studies (sensitivity and specificity) with covariates (suggested cut-offs, age, education and country) and summary received operating characteristic curve (sROC) are presented.The results showed a wide range in suggested cutoffs for MCI cross culturally, with variability in levels of sensitivity and specificity ranging from low to high. Poor methodological rigour appears to have affected reported accuracy and validity of the MoCA.The review highlights the necessity for cross cultural considerations when using the MoCA, and recognizing it as a screen and not a diagnostic tool. Appropriate cutoffs and point adjustments for education are suggested.2

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“…17–19 An estimated 90 million U.S adults are thought to have limited health literacy which has large social and political implications given the association with poor health outcomes. 16 Both education and health literacy are strongly linked to racial disparities and health promotion; 20 however, the association of either of these two factors with patient activation are less well-described.…”

mentioning

confidence: 99%

Health Literacy and Education as Mediators of Racial Disparities in Patient Activation Within an Elderly Patient Cohort

Eneanya¹,

Winter²,

Cabral³

et al. 2016

Journal of Health Care for the Poor and Underserved

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The Patient Activation Measure (PAM) assesses facets of patient engagement to identify proactive health behaviors and is an important predictor of health outcomes. Health literacy and education are also important for patient participation and successful navigation of the health care system. Because health literacy, education and patient activation are associated with racial disparities, we sought to investigate whether health literacy and education would mediate racial differences in patient activation. Participants were 265 older adults who participated in a computer-based exercise interventional study. Health literacy was assessed using the Test of Functional Health Literacy in Adults (TOFHLA). Of 210 eligible participants, 72% self-identified as Black and 28% as White. In adjusted analyses, education and health literacy each significantly reduced racial differences in patient activation. These findings are especially important when considering emerging data on the significance of patient activation and new strategies to increase patient engagement.

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The Role of Early-Life Educational Quality and Literacy in Explaining Racial Disparities in Cognition in Late Life

Abstract: Early-life educational quality and literacy in late life explain a substantial portion of race-related disparities in late-life cognitive function.

Cited by 209 publications

References 46 publications

Childhood deprivation and later-life cognitive function in a population-based study of older rural South Africans

Childhood deprivation and later-life cognitive function in a population-based study of older rural South Africans

Cross-Cultural Applicability of the Montreal Cognitive Assessment (MoCA): A Systematic Review

Health Literacy and Education as Mediators of Racial Disparities in Patient Activation Within an Elderly Patient Cohort

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