Wong Roger, Mansour Amer
Department of Public Health and Preventive Medicine, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA.
Department of Geriatrics, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA.
BJPsych Open. 2025 Apr 17;11(3):e88. doi: 10.1192/bjo.2025.45.
Subjective cognitive decline (SCD) is defined as self-reported increase in confusion or memory loss. There is limited research on the interplay between rural-urban residence and education on SCD.
Examine rural-urban differences in SCD, and whether education moderates this relationship.
Respondents aged ≥45 years were queried about SCD in the 2022 Behavioral Risk Factor Surveillance System data, creating a sample size of 63 890. A logistic regression analysed the association between rural-urban residence and SCD, and moderation was tested by an interaction with education.
SCD was more common among rural (12.0%) compared with urban (10.7%) residents. Rural residence was associated with 9% significantly higher odds of SCD compared with urban residence after adjusting for sociodemographic and health covariates (adjusted odds ratio (aOR) = 1.09, = 0.01). There was a negative relationship between education level and SCD, including the association of college degree with 15% lower odds of SCD compared with less than high school degree (aOR = 0.85, < 0.01). Education was a significant moderator, with higher education associated with lower odds of SCD for urban, but not rural, residents.
Rural setting and lower education were associated with higher odds of SCD, but higher education was protective for only urban residents. These results indicate that higher education may be a gateway for more opportunities and resources in urban settings, with cascading impacts on cognition. Future research should examine reasons for the diverging cognitive benefits from education depending on rural-urban residence.
主观认知下降（SCD）被定义为自我报告的困惑或记忆力减退。关于城乡居住情况与教育程度对SCD的相互作用的研究有限。
研究SCD的城乡差异，以及教育程度是否调节这种关系。
在2022年行为危险因素监测系统数据中询问年龄≥45岁的受访者有关SCD的情况，样本量为63890。采用逻辑回归分析城乡居住情况与SCD之间的关联，并通过与教育程度的交互作用来检验调节作用。
与城市居民（10.7%）相比，农村居民（12.0%）中SCD更为常见。在调整社会人口统计学和健康协变量后，农村居民患SCD的几率比城市居民高9%（调整后的优势比（aOR）=1.09，P=0.01）。教育程度与SCD呈负相关，包括与高中学历以下相比，大学学历患SCD的几率低15%（aOR=0.85，P<0.01）。教育是一个显著的调节因素，对于城市居民而非农村居民，较高的教育程度与较低的SCD几率相关。
农村环境和较低的教育程度与较高的SCD几率相关，但较高的教育程度仅对城市居民具有保护作用。这些结果表明，高等教育可能是城市环境中获得更多机会和资源的途径，对认知产生连锁影响。未来的研究应探讨根据城乡居住情况教育带来不同认知益处的原因。
