Lin Zhuoer, Chen Xi
Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
Department of Economics, Yale University, New Haven, CT, USA.
medRxiv. 2023 Oct 15:2023.10.12.23296954. doi: 10.1101/2023.10.12.23296954.
Growing evidence suggests that place of birth (PoB) and related circumstances may have long-lasting and multiplicative contributions to various later-life outcomes. However, the specific contributions to different domains of cognitive function in late life remain less understood. This study aimed to investigate the extent to which PoB contribute to a wide range of later-life cognitive outcomes.
A nationally representative sample of Americans aged 65 and older (N=3,216) from the Health and Retirement Study (HRS) Harmonized Cognitive Assessment Protocol (HCAP) was utilized. Cognitive outcomes were assessed in HCAP and linked to HRS state-level PoB data to explore the contribution of birthplace to later-life cognitive disparities. Regression-based Shapley decompositions were employed to quantify this contribution.
PoB significantly contributed to all assessed cognitive outcomes including memory, executive function, language and fluency, visuospatial function, orientation, global cognitive performance, cognitive impairment and dementia. Geographic disparities in cognitive outcomes were evident, with individuals born in US southern states and foreign-born individuals performing worse than those born in other states. PoB overall accounted for 2.4-13.9% of the total variance in cognition after adjusting for age and sex. This contribution reduced by half when adjusting for a rich set of sociodemographic and health factors over the life course, but PoB still independently explained 2.0-7.1% of the total variance in cognition.
PoB has lasting contributions to later-life cognitive health, with significant geographic disparities observed. Addressing these disparities requires promoting more equalized place-based policies, resources, and early-life environments to improve health equities over the life course.
越来越多的证据表明，出生地（PoB）及相关情况可能对各种晚年结局产生长期且多方面的影响。然而，对晚年不同认知功能领域的具体影响仍了解不足。本研究旨在调查出生地对广泛的晚年认知结局的影响程度。
使用来自健康与退休研究（HRS）统一认知评估协议（HCAP）的具有全国代表性的65岁及以上美国人样本（N = 3216）。在HCAP中评估认知结局，并将其与HRS州级出生地数据相关联，以探讨出生地对晚年认知差异的影响。采用基于回归的夏普利分解来量化这种影响。
出生地对所有评估的认知结局均有显著影响，包括记忆、执行功能、语言与流畅性、视觉空间功能、定向、整体认知表现、认知障碍和痴呆。认知结局的地理差异明显，出生在美国南部各州的人和外国出生的人比出生在其他州的人表现更差。在调整年龄和性别后，出生地总体上占认知总方差的2.4 - 13.9%。在调整了一生中丰富的社会人口学和健康因素后，这种影响减少了一半，但出生地仍独立解释了认知总方差的2.0 - 7.1%。
出生地对晚年认知健康有持久影响，存在显著的地理差异。解决这些差异需要促进更均衡的基于地点的政策、资源和早期生活环境，以在整个生命过程中改善健康公平性。
