基于人群的南非农村老年人研究：儿童期剥夺与晚年认知功能。
Childhood deprivation and later-life cognitive function in a population-based study of older rural South Africans.
机构信息
Harvard Center for Population and Development Studies, Cambridge, MA, USA.
Harvard Center for Population and Development Studies, Cambridge, MA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
出版信息
Soc Sci Med. 2017 Oct;190:20-28. doi: 10.1016/j.socscimed.2017.08.009. Epub 2017 Aug 14.
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.
背景
在南非，几乎没有研究评估认知老化的生命历程驱动因素。
目的
我们研究了自我报告的儿童期健康和父亲在儿童时期的职业与晚年认知功能评分之间的关系，以及在南非前种族隔离时代的一个地区生活的老年南非人中，教育程度是否会调节这些关系。
方法
本研究数据来自“非洲的健康与老龄化：一项对 INDEPTH 社区的纵向研究”（HAALSI）的基线评估，该研究是一项基于人群的研究，于 2015 年在南非农村 Agincourt 分区调查了 5059 名年龄≥40 岁的男性和女性。在研究访谈中，自我报告了儿童期健康、父亲在儿童时期的职业和受教育年限。认知测量评估了时间取向、计算能力和单词回忆，这些都被纳入了一个标准化的潜在认知功能评分变量中。使用线性回归模型，根据年龄、性别和出生国调整了每个儿童时期风险因素的总效应和直接效应，以及受教育年限的间接效应。
结果
较差的儿童健康状况预示着认知评分较低（总效应=-0.28；95%CI=-0.35，-0.21，与健康相比）；这种效应不受教育程度的影响。在儿童时期有一个从事专业工作的父亲，虽然这种情况很少见（占样本的 3%），但却预示着更好的认知评分（总效应=0.25；95%CI=0.10，0.40，与样本中 29%的非熟练体力劳动者相比）。这种效应的一半是由教育程度介导的。教育程度与晚年认知功能评分呈线性相关（每增加一年教育程度，认知功能评分提高 0.09；95%CI=0.09，0.10）。
结论
在这个后种族隔离、农村的南非背景下，自我报告儿童期健康状况较差或其父亲从事非熟练体力劳动的老年成年人认知结果相对较差。教育程度强烈预测认知结果，并且在这种情况下，似乎部分是晚年认知健康的社会分层机制。
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