麻豆传媒

Early life experiences were associated with disparities in cognitive outcomes for Black and white people over 50, a cross-sectional study found.

On a 27-point scale, cognitive scores were lower among Black participants (13.5 points) than among white participants (15.8 points), according to Xi Chen, PhD, of the Yale School of Public Health, in New Haven, Connecticut, and co-authors. The prevalence of cognitive impairment -- a score less than 12 -- was significantly higher among Black participants (33.6 percentage points) than among White participants (16.4 percentage points).

Overall, differences in early life circumstances, which included educational experiences, were associated with 61.5% of racial disparities in cognitive scores and 82.3% of racial disparities in cognitive impairment, Chen and colleagues reported in .

Educational experiences were associated with 35.2% of disparities in cognitive scores and 48.6% of disparities in cognitive impairment, they noted. School racial segregation (all segregated schooling before college) was associated with 28.8% of disparities in cognitive scores and 39.7% of disparities in cognitive impairment.

Of early life experiences associated with later life cognition, "school segregation really stands out to be the most important one, and more important than the measure of the years of education," Chen told 麻豆传媒.

Past studies have found that dementia is almost twice as prevalent among Black adults than their white peers, even after accounting for age, sex, and some aspects of education. Mid- to late-life factors have been tied to cognitive outcomes in older Americans, but education in early life has been studied less.

The study highlights the need to look beyond quantitative measures of educational attainment, observed Raegan Durant, MD, MPH, of the University of Alabama at Birmingham, in an .

"Black students attending desegregated schools likely experienced the stress of both interpersonal and institutional racism in a more direct manner than Black students attending segregated schools," Durant wrote. Conversely, some Black students who attended segregated schools thrived educationally, he noted.

"To better understand the lifelong health effects of school segregation, we must also identify and explore the mechanisms of resilience driving those Black individuals who achieved academically despite social determinants that were often systematically aligned against them," Durant pointed out.

"More detailed assessments of the qualitative aspects of early-life education, such as segregation, may be essential to understanding the underpinnings of the racial differences in the association of education and health outcomes," he added.

Chen and co-authors used data from the (HRS), a large nationally representative study of adults over age 50. Factors of early life circumstances were self-reported and came from three HRS components, which were done at various time periods: the HRS core survey, the Life History Mail Survey, and the Enhanced Face-to-Face Interview.

A total of 9,015 participants (18.1% Black and 81.9% white) were included. Among Black participants, the mean age was 69.2 and 67.0% were women. Among white participants, the mean age was 73.2 and 59.7% were women.

Cognitive scores were measured by a range of tests adapted from the Telephone Interview for Cognitive Status (TICS) used in the HRS, and included immediate word recall, delayed word recall, serial 7s subtraction, and backward counting. The score ranged from 0-27 points, with a score of less than 12 indicating cognitive impairment.

Researchers evaluated traditional early-life circumstances in one model, which included age cohort and numerous regional, financial, health, trauma, and family relationship factors, along with years of educational attainment. A second model incorporated early life educational experience, which included numerous family education and schooling factors, including owning books, preschool attendance, and school segregation.

"The findings of this cross-sectional study suggest that less favorable early-life circumstances are associated with clinically meaningful racial disparities in late-life cognition," Chen and co-authors wrote. "Policies that improve educational equity have the potential to reduce racial disparities in cognition in older ages."

People with impaired cognition or other health problems may have been less likely to participate in the study, the researchers acknowledged. Sample sizes prevented them from studying other racial and ethnic groups, and dementia could not be evaluated as an outcome due to low prevalence.

The researchers also were unable to assess variation in quality among segregated schools, or account for unknown early life factors.

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