Quiñones Ana R, Chen Siting, Nagel Corey L, Botoseneanu Anda, Allore Heather G, Newsom Jason T, Thielke Stephen, Kaye Jeffrey
Department of Family Medicine, Oregon Health & Science University, USA.
OHSU-PSU School of Public Health, Portland, OR, USA.
SSM Popul Health. 2022 Apr 4;18:101084. doi: 10.1016/j.ssmph.2022.101084. eCollection 2022 Jun.
Evaluating multimorbidity combinations, racial/ethnic background, educational attainment, and sex associations with age-related cognitive changes is critical to clarifying the health, sociodemographic, and socioeconomic mechanisms associated with cognitive function in later life. Data from the 2011-2018 National Health and Aging Trends Study for respondents aged 65 years and older (N = 10,548, mean age = 77.5) were analyzed using linear mixed effect models. Racial/ethnic differences (mutually-exclusive groups: non-Latino White, non-Latino Black, and Latino) in cognitive trajectories and significant interactions with sex and education (<high school, high school, some college, and ≥ college degree) were evaluated. Models included sex, education, ever covered by Medicaid, coupled status, waist-height ratio, study cohort, and chronic disease category (no diseases; one disease; multimorbidity; multimorbidity; multimorbidity; and multimorbidity). In covariate-adjusted models, Black (b = -1.31, 95% CI: 1.74,-0.89) and Latino (b = -0.83, 95% CI: 1.58,-0.07) respondents had lower cognitive scores at age 65 and steeper declines with age (b = -0.08, 95% CI: -0.15,-0.01; b = -0.20, 95% CI: 0.34,-0.05, respectively) compared with White respondents. Cognitive scores were lower among respondents with (b = -0.28, 95% CI: 0.54,-0.01) and (b = -0.56, 95% CI: 0.86,-0.27) multimorbidity compared with respondents with none of the chronic diseases of interest. In interaction models, protective associations by female sex and higher education were not observed among minority racial/ethnic groups. It is important to develop interventions to postpone cognitive decline among older Black and Latino adults.
评估多种疾病组合、种族/族裔背景、教育程度以及性别与年龄相关认知变化之间的关联，对于阐明与晚年认知功能相关的健康、社会人口统计学和社会经济机制至关重要。使用线性混合效应模型分析了2011 - 2018年国家健康与老龄化趋势研究中65岁及以上受访者的数据（N = 10,548，平均年龄 = 77.5）。评估了认知轨迹中的种族/族裔差异（相互排斥的群体：非拉丁裔白人、非拉丁裔黑人、拉丁裔）以及与性别和教育程度（高中以下、高中、大专、本科及以上）的显著交互作用。模型包括性别、教育程度、是否曾享受医疗补助、婚姻状况、腰高比、研究队列以及慢性病类别（无疾病；一种疾病；多种疾病；多种疾病；多种疾病；多种疾病）。在协变量调整模型中，与白人受访者相比，黑人（b = -1.31，95% CI：1.74，-0.89）和拉丁裔受访者（b = -0.83，95% CI：1.58，-0.07）在65岁时认知得分较低，且随年龄增长下降幅度更大（分别为b = -0.08，95% CI：-0.15，-0.01；b = -0.20，95% CI：0.34，-0.05）。与未患所关注慢性病的受访者相比，患有多种疾病（b = -0.28，95% CI：0.54，-0.01）和多种疾病（b = -0.56，95% CI：0.86，-0.27）的受访者认知得分较低。在交互作用模型中，未在少数种族/族裔群体中观察到女性性别和高等教育的保护作用。制定干预措施以延缓老年黑人和拉丁裔成年人的认知衰退非常重要。
