Nativity differences in lifecourse socioeconomic position and late‐life cognition among KHANDLE participants

Abstract

AbstractBackgroundSocioeconomic position (SEP) in childhood and adulthood is associated with late‐life cognition. Less is known about how SEP changes may be associated with late‐life cognition in diverse cohorts.MethodsThe Kaiser Healthy Aging and Diverse Life Experiences Study (KHANDLE) is a cohort of community‐dwelling Kaiser Permanente members who reside in the San Francisco Bay area and Sacramento valley (n=1,708; Asians (24%), Blacks (26%), Latinos (20%) and Whites (30%)). KHANDLE aims to evaluate how lifecourse and sociocultural factors influence late‐life brain health and cognitive decline and contribute to race/ethnic disparities. We used linear regression to test the association between lifecourse SEP trajectories and late‐life cognition and tested if these associations differed by US vs. foreign nativity. Childhood SEP is a composite of parents’ education (≥HS vs. <HS), childhood hunger, and self‐reported family financial status. Adult SEP included participants’ education (≥HS vs. <HS), late‐life low income status (e.g. qualified for low‐income welfare programs), and self‐reported social status. Participants were classified as having consistently high SEP (HH), low childhood/high adult SEP (LH), high childhood/low adult SEP (HL), or consistently low SEP (LL). Executive function, semantic memory and verbal episodic memory measured with the Spanish and English Neuropsychological Assessment Scales (SENAS) were z‐standardized and averaged for overall cognition. Pooled analyses adjusted for age, race/ethnicity, gender, and foreign nativity.ResultsOverall, participants classified as LH did not differ from HH (ref.) in any cognitive domain, while those classified as HL and LL had lower cognition than HH in all domains (see table). We observed a significant interaction of US vs. foreign birth and lifecourse SES trajectory for semantic memory (p=0.01), but no other domain. Stratified analyses demonstrated a similar pattern to pooled. However, foreign‐born participants HL participants had significantly lower overall cognition (p=0.03), and verbal memory (p=0.02) than US‐born HL participants. By contrast, foreign‐born LH participants performed significantly better than US‐born LH in semantic memory (p=0.01).ConclusionsThose with high Adult SEP had the best cognitive function, regardless of childhood SEP or nativity. In some measures of cognition, foreign‐born HL participants performed worse than US‐born, while foreign‐born LH performed better.