Relationship between state‐level administrative school quality data, years of education, cognitive decline and dementia risk

Abstract

AbstractBackgroundWe examined indicators of state‐level administrative school quality as predictors of cognitive decline and dementia risk in later life across racial/ethnic by sex/gender groups.MethodParticipants included 2,446 men and women enrolled in the Washington Heights/Inwood Columbia Aging Project (WHICAP) who attended elementary school in the U.S., including 858 non‐Hispanic Whites (NHWs) and 1,588 non‐Hispanic Blacks (Blacks) followed up to 21 years. Cognitive outcomes were memory and language trajectories. A school quality indicator was created using U.S. census microsample data to combine historical measures of state compulsory schooling (mandatory enrollment age, minimum drop out age, and minimum work permit age) and school quality (term length, student‐teacher ratio, and percent attendance) on a scale corresponding to years of education via regression. The school quality indicator values were linked to WHICAP individual data via birth state, birth year, sex/gender, and race/ethnicity (black or NHW). Multiple‐group growth curve modeling and multiple‐group Cox regressions analyses were used to examine associations between school quality, cognitive decline, and dementia risk across racial/ethnic by sex/gender groups.ResultAfter adjusting for age, childhood SES, and state of childhood residence, higher quality of early‐life education was associated with level and change in language performance across groups, level of memory performance in Black women, and change in memory for NHWs and Black women. Higher quality of education was associated with lower risk of dementia for NHW women, Black men and women. Quality of education was not associated with dementia risk for NHW men after accounting for covariates. When years of education was included in the models, the influence of school quality on dementia risk and level and change in memory and language performance was fully attenuated for Black men and partially attenuated for NHWs and Black women.ConclusionQuality of early‐life education positively impacts cognitive outcomes and dementia risk later in life. Our results suggest an indirect relationship of school quality to late‐life cognitive outcomes through enabling additional years of educational attainment. Associations also varied across racial/ethnic by sex/gender groups. These findings provide evidence that later life brain health is influenced by early‐life state educational policies.