Abstract
Background: We tested the hypothesis that lower childhood SES is associated with greater age-and disease-related cognitive decline. We further examined potential protective effects of high adulthood occupational complexity in the association of childhood SES with cognitive decline. Methods: Childhood neighborhood SES (child nSES) was ascertained at midlife among 12440 ARIC participants using retrospective historical county-level census-based measures of median household income, value of owner occupied housing units, percent of households receiving interest, dividend, or net rental income, educational attainment, and proportion of adults in professional, management, or executive occupations. An occupational complexity index (OCI) was derived from self-reported occupational categories at baseline. Cognitive function was assessed at ARIC visits 2 (1990-1993), 4 (1996-1998), and 5 (2011-2013) according to performance on tests of memory, executive function/processing speed and language. A composite global cognition z-score was estimated, with missing data imputed using multiple imputation by chained equations. Linear mixed effects models, adjusted for baseline age, sex, and race-study center, were used to examine the association of distribution-based tertiles of the child nSES summary score with baseline and 20-year change in cognitive function. We further examined interactions by OCI tertiles. Results: Global cognitive z scores in adulthood were persistently higher at baseline among participants with high (Visit 2 β =0.545 (95% CI 0.514, 0.576) as compared to intermediate (Visit 2 β=0.348 (95% CI 0.317, 0.381)) and low (Visit 2 β = 0.007 (95% CI -0.030, 0.044) child nSES. Participants with high,as compared to low, OCI, had higher baseline cognitive function across all tertiles of child nSES (Figure, p<0.01). Conclusion: The positive association of child nSES with adult cognitive function is modified by adulthood occupational complexity. Child nSES is not associated with a 20-year cognitive change.
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