KHANDLE研究中一生的农村居住经历与晚年认知衰退：一项因果推断研究
Rural residence across the life course and late-life cognitive decline in KHANDLE: A causal inference study.
作者信息
Peterson Rachel L, Gilsanz Paola, Lor Yi, George Kristen M, Ko Michelle, Wagner Jenny, Soh Yenee, Meyer Oanh L, Glymour M Maria, Whitmer Rachel A
机构信息
School of Public and Community Health Sciences University of Montana Missoula Montana USA.
Division of Research Kaiser Permanente Northern California Oakland California USA.
出版信息
Alzheimers Dement (Amst). 2023 Feb 3;15(1):e12399. doi: 10.1002/dad2.12399. eCollection 2023 Jan-Mar.
BACKGROUND
Modifiable risks for dementia are more prevalent in rural populations, yet there is a dearth of research examining life course rural residence on late-life cognitive decline.
METHODS
The association of rural residence and socioeconomic status (SES) in childhood and adulthood with late-life cognitive domains (verbal episodic memory, executive function, and semantic memory) and cognitive decline in the Kaiser Healthy Aging and Diverse Life Experiences cohort was estimated using marginal structural models with stabilized inverse probability weights.
RESULTS
After adjusting for time-varying SES, the estimated marginal effect of rural residence in childhood was harmful for both executive function ( = -0.19, 95% confidence interval [CI] = -0.32, -0.06) and verbal episodic memory ( = -0.22, 95% CI = -0.35, -0.08). Effects of adult rural residence were imprecisely estimated with beneficial point estimates for both executive function ( = 0.19; 95% CI = -0.07, 0.44) and verbal episodic memory ( = 0.24, 95% CI = -0.07, 0.55).
CONCLUSIONS
Childhood rurality is associated with poorer late-life cognition independent of SES.
背景
痴呆症的可改变风险在农村人口中更为普遍，但缺乏关于终生农村居住情况对晚年认知能力下降影响的研究。
方法
在凯撒健康老龄化与多样生活经历队列中，采用具有稳定逆概率权重的边际结构模型，估计童年和成年期农村居住情况及社会经济地位（SES）与晚年认知领域（言语情景记忆、执行功能和语义记忆）及认知能力下降之间的关联。
结果
在对随时间变化的SES进行调整后，童年期农村居住的估计边际效应对执行功能（β = -0.19，95%置信区间[CI] = -0.32，-0.06）和言语情景记忆（β = -0.22，95%CI = -0.35，-0.08）均有害。成年期农村居住的影响估计不精确，执行功能（β = 0.19；95%CI = -0.07，0.44）和言语情景记忆（β = 0.24，95%CI = -0.07，0.55）的点估计均为有益。
结论
童年期居住在农村与晚年较差的认知能力有关，且独立于SES。
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