Intergenerational educational attainment among Latino and White men and women and incident risk for dementia and cognitive impairment without dementia

Abstract

AbstractBackgroundLate life cognitive outcomes may depend on an individuals’ and their parents’ educational attainment levels. We evaluate the association of intergenerational education on dementia/Cognitive impairment without dementia (CIND) risk for Latino compared to White men and women.MethodWe analyzed data from 26,643 US Health and Retirement Study (HRS) Latino and non‐Hispanic white participants from 1998‐2016 (new entry cohorts enrolled every 6 years). Age‐eligible (50+ years at enrollment) respondents without probable dementia/CIND at baseline were included in the analyses with follow‐up waves every 2 years. Exposure was a 4‐category variable based on participants’ and parents’ (highest of mother’s or father’s) education in years: 1) first‐generation high‐school graduate (participant≥12; parents’ education<12); 2) multi‐generation (both≥12: reference); 3) only parents graduated high school but not respondent (participant<12; parent(s)≥12); and 4) neither parents nor participant completed high school (both<12). Probable dementia/CIND cases were classified using the Langa‐Weir 27‐point scale. We used Cox proportional hazard models to evaluate the association between education and dementia/CIND risk and included interactions to evaluate effect modification by gender and race/ethnicity.ResultOur sample was 9% Latino, 46% men and 31% were classified with probable dementia/CIND during follow‐up from 2000‐2016 (mean follow‐up: 9 years). Compared to multi‐gen, first‐gen graduates showed higher dementia/CIND risk (HR:1.49 [95% CI: 1.40, 1.60]) independent of demographic factors. The magnitude of increased risk was smaller for men compared to women (interaction term:0.78 [0.70, 0.89]) and did not vary for Latinos compared to whites. Compared to multi‐gen, only parent graduate showed higher dementia/CIND risk (HR:2.21 [2.05, 2.37]), and the magnitude of risk was greatest for Latino compared to white men (interaction term:1.31 [0.77, 2.23]). Lastly, compared to multi‐gen, neither‐graduates showed higher dementia/CIND risk (HR:2.37 [2.14, 2.64]); association did not vary by gender or race/ethnicity.ConclusionWhile all groups showed increased risk for dementia/CIND compared to multi‐gen high school graduates, the most disadvantaged were downwardly mobile Latino men. Our findings suggest declines in dementia risk potentially attributable to growing educational attainment may persist in the future and be especially marked for racial/ethnic groups historically excluded from educational policies rendering high school completion.