Department of Epidemiology, University of North Carolina at Chapel Hill.
Department of Epidemiology, University of Kentucky, Lexington.
JAMA Netw Open. 2023 Aug 1;6(8):e2327421. doi: 10.1001/jamanetworkopen.2023.27421.
Early-life socioeconomic adversity may be associated with poor cognitive health over the life course.
To examine the association of childhood and midlife neighborhood socioeconomic position (nSEP) with cognitive decline.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included 5711 men and women enrolled in the community-based Atherosclerosis Risk in Communities (ARIC) Study with repeated cognitive data measured over a median 27.0 years (IQR, 26.0-27.9 years) (1990-2019). Statistical analysis was performed from December 2022 through March 2023.
Residence addresses for ARIC Study cohort participants were obtained at midlife (1990-1993) and as recalled addresses at 10 years of age (childhood). A composite nSEP z score was created as a sum of z scores for US Census-based measures of median household income; median value of owner-occupied housing units; percentage of households receiving interest, dividend, or net rental income; percentage of adults with a high school degree; percentage of adults with a college degree; and percentage of adults in professional, managerial, or executive occupations. Childhood nSEP and midlife nSEP were modeled as continuous measures and discretized into tertiles.
A factor score for global cognition was derived from a battery of cognitive tests administered at 5 in-person visits from baseline to 2019. The rate of cognitive decline from 50 to 90 years of age was calculated by fitting mixed-effects linear regression models with age as the time scale and adjusted for race, sex, birth decade, educational level, and presence of the apolipoprotein E ε4 allele.
Among 5711 ARIC Study participants (mean [SD] baseline age, 55.1 [4.7] years; 3372 women [59.0%]; and 1313 Black participants [23.0%]), the median rate of cognitive decline was -0.33 SDs (IQR, -0.49 to -0.20 SDs) per decade. In adjusted analyses, each 1-SD-higher childhood nSEP score was associated with a slower (β, -9.2%; 95% CI, -12.1% to -6.4%) rate of cognitive decline relative to the sample median. A comparable association was observed when comparing the highest tertile with the lowest tertile of childhood nSEP (β, -17.7%; 95% CI, -24.1% to -11.3%). Midlife nSEP was not associated with the rate of cognitive decline.
In this cohort study of contextual factors associated with cognitive decline, childhood nSEP was inversely associated with trajectories of cognitive function throughout adulthood.
早期生活中的社会经济逆境可能与整个生命周期中的认知健康状况不佳有关。
研究童年和中年时期邻里社会经济地位（nSEP）与认知能力下降的关系。
设计、地点和参与者：本队列研究纳入了参加社区动脉粥样硬化风险研究（ARIC）的 5711 名男性和女性，他们的认知数据在中位数为 27.0 年（IQR，26.0-27.9 年）（1990-2019 年）的多次重复测量中进行评估。统计分析于 2023 年 3 月通过。
在中年（1990-1993 年）和 10 岁时（童年）回忆地址时，获取 ARIC 研究队列参与者的居住地址。作为一个总和，创建了一个 nSEP z 分数，它由基于美国人口普查的家庭收入中位数、自住房屋单位中位数、接受利息、股息或净租金收入的家庭百分比、高中教育程度成年人百分比、大学教育程度成年人百分比和专业、管理或行政职业成年人百分比的 z 分数组成。童年时期的 nSEP 和中年时期的 nSEP 被建模为连续测量值，并分为三分位数。
从基线到 2019 年进行的 5 次面对面访问中，通过一系列认知测试得出了全球认知的因子分数。通过拟合以年龄为时间尺度的混合效应线性回归模型，计算从 50 岁到 90 岁的认知衰退率，并调整了种族、性别、出生年代、教育程度和载脂蛋白 E ε4 等位基因的存在。
在 5711 名 ARIC 研究参与者中（平均[标准差]基线年龄为 55.1[4.7]岁；女性 3372 名[59.0%]；黑人参与者 1313 名[23.0%]），认知衰退的中位数率为每十年-0.33 标准差（IQR，-0.49 至-0.20 标准差）。在调整分析中，每个 1-SD 更高的儿童 nSEP 评分与相对于样本中位数的认知衰退率更慢（β，-9.2%；95%CI，-12.1%至-6.4%）相关。当比较童年时期 nSEP 的最高三分位与最低三分位时，观察到类似的关联（β，-17.7%；95%CI，-24.1%至-11.3%）。中年 nSEP 与认知衰退率无关。
在这项与认知衰退相关的背景因素的队列研究中，儿童时期的 nSEP 与整个成年期认知功能的轨迹呈负相关。
