Del Brutto Oscar H, Mera Robertino M, Rumbea Denisse A, Recalde Bettsy Y, Sedler Mark J
School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador.
Biostatistics/Epidemiology, Freenome, Inc., South San Francisco, California, USA.
Int J Geriatr Psychiatry. 2022 Jan;37(2). doi: 10.1002/gps.5671.
There is limited information on factors associated with poor cognitive performance in rural settings of Low- and Middle-Income Countries. Using the Three Villages Study Cohort, we assessed whether social determinants of health (SDH) play a role in cognitive performance among older adults living in rural Ecuador.
Atahualpa, El Tambo and Prosperidad residents aged ≥60 years received measurement of SDH by means of the Gijon Scale together with a Montreal Cognitive Assessment (MoCA). The association between SDH and cognitive performance (dependent variable) was assessed by generalized linear models, adjusted for demographics, years of education, cardiovascular risk factors, symptoms of depression and biomarkers of structural brain damage.
We included 513 individuals (mean age: 67.9 ± 7.3 years; 58% women). The mean score on the Gijon scale was 9.9 ± 2.9 points, with 237 subjects classified as having a high social risk (≥10 points). The mean MoCA score was 19.6 ± 5.4 points. Locally weighted scatterplot smoothing showed an inverse linear relationship between SDH and MoCA scores. SDH and MoCA scores were inversely associated in linear models adjusted for clinical covariates (β: -0.17; 95% C.I.: -0.32 to -0.02; p = 0.020), neuroimaging covariates (β: -0.17; 95% C.I.: -0.31 to -0.03; p = 0.018), as well as in the most parsimonious model (β: -0.16; 95% C.I.: -1.30 to -0.02; p = 0.026).
Study results provide robust evidence of an inverse association between SDH and cognitive performance. Interventions and programs aimed to reduce disparities in the social risk of older adults living in underserved rural populations may improve cognitive performance in these individuals.
关于低收入和中等收入国家农村地区认知功能不佳相关因素的信息有限。我们利用三村研究队列，评估健康的社会决定因素（SDH）在厄瓜多尔农村地区老年人的认知功能中是否起作用。
来自阿塔瓦尔帕、埃尔坦博和繁荣镇年龄≥60岁的居民通过希洪量表接受了SDH测量，并进行了蒙特利尔认知评估（MoCA）。通过广义线性模型评估SDH与认知功能（因变量）之间的关联，并对人口统计学、受教育年限、心血管危险因素、抑郁症状和脑结构损伤生物标志物进行了调整。
我们纳入了513名个体（平均年龄：67.9±7.3岁；58%为女性）。希洪量表的平均得分为9.9±2.9分，237名受试者被归类为具有高社会风险（≥10分）。MoCA的平均得分为19.6±5.4分。局部加权散点图平滑显示SDH与MoCA得分之间呈负线性关系。在调整了临床协变量的线性模型中，SDH与MoCA得分呈负相关（β：-0.17；95%置信区间：-0.32至-0.02；p = 0.020），在调整了神经影像协变量的模型中也是如此（β：-0.17；95%置信区间：-0.31至-0.03；p = 0.018），在最简约模型中同样如此（β：-0.16；95%置信区间：-1.30至-0.02；p = 0.026）。
研究结果有力地证明了SDH与认知功能之间存在负相关。旨在减少生活在服务不足农村人口中的老年人社会风险差异的干预措施和项目可能会改善这些人的认知功能。
