Neighborhood socioeconomic status and cognitive function in women.

OBJECTIVES We examined whether neighborhood socioeconomic status (NSES) is associated with cognitive functioning in older US women and whether this relationship is explained by associations between NSES and vascular, health behavior, and psychosocial factors. METHODS We assessed women aged 65 to 81 years (n = 7479) who were free of dementia and took part in the Women's Health Initiative Memory Study. Linear mixed models examined the cross-sectional association between an NSES index and cognitive functioning scores. A base model adjusted for age, race/ethnicity, education, income, marital status, and hysterectomy. Three groups of potential confounders were examined in separate models: vascular, health behavior, and psychosocial factors. RESULTS Living in a neighborhood with a 1-unit higher NSES value was associated with a level of cognitive functioning that was 0.022 standard deviations higher (P = .02). The association was attenuated but still marginally significant (P < .1) after adjustment for confounders and, according to interaction tests, stronger among younger and non-White women. CONCLUSIONS The socioeconomic status of a woman's neighborhood may influence her cognitive functioning. This relationship is only partially explained by vascular, health behavior, or psychosocial factors. Future research is needed on the longitudinal relationships between NSES, cognitive impairment, and cognitive decline.

[1]  S. Resnick,et al.  Long‐Term Effects of Conjugated Equine Estrogen Therapies on Domain‐Specific Cognitive Function: Results from the Women's Health Initiative Study of Cognitive Aging Extension , 2010, Journal of the American Geriatrics Society.

[2]  S. Resnick,et al.  Brain volumes, cognitive impairment, and conjugated equine estrogens. , 2009, The journals of gerontology. Series A, Biological sciences and medical sciences.

[3]  B. Shukitt-Hale,et al.  Grape juice, berries, and walnuts affect brain aging and behavior. , 2009, The Journal of nutrition.

[4]  T. Glass,et al.  Neighborhoods, Aging, and Functional Limitations , 2009 .

[5]  Martin J Shipley,et al.  Health behaviors from early to late midlife as predictors of cognitive function: The Whitehall II study. , 2009, American journal of epidemiology.

[6]  K. Sheffield,et al.  Neighborhood context and cognitive decline in older Mexican Americans: results from the Hispanic Established Populations for Epidemiologic Studies of the Elderly. , 2009, American journal of epidemiology.

[7]  C Davatzikos,et al.  Postmenopausal hormone therapy and regional brain volumes , 2009, Neurology.

[8]  L. Fried,et al.  Exploring the effects of an "everyday" activity program on executive function and memory in older adults: Experience Corps. , 2008, The Gerontologist.

[9]  Vicki A Freedman,et al.  Neighborhoods and obesity in later life. , 2008, American journal of public health.

[10]  S. Galea,et al.  Are neighbourhood characteristics associated with depressive symptoms? A review of evidence , 2008, Journal of Epidemiology & Community Health.

[11]  Lauren Hale,et al.  Neighborhood socioeconomic status and fruit and vegetable intake among whites, blacks, and Mexican Americans in the United States. , 2008, The American journal of clinical nutrition.

[12]  D. Melzer,et al.  Neighborhood Deprivation, Individual Socioeconomic Status, and Cognitive Function in Older People: Analyses from the English Longitudinal Study of Ageing , 2008, Journal of the American Geriatrics Society.

[13]  K. Welsh-Bohmer,et al.  Antioxidant intake and cognitive function of elderly men and women: the Cache County Study. , 2007, The journal of nutrition, health & aging.

[14]  J. Chodosh,et al.  Depressive symptoms as a predictor of cognitive decline: MacArthur Studies of Successful Aging. , 2007, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[15]  K. Sundquist,et al.  Inequities in CHD incidence and case fatality by neighborhood deprivation. , 2007, American journal of preventive medicine.

[16]  Jonathan J. Evans,et al.  A review of screening tests for cognitive impairment , 2006, Journal of Neurology, Neurosurgery & Psychiatry.

[17]  S. Resnick,et al.  Association between Alcohol Intake and Domain-Specific Cognitive Function in Older Women , 2006, Neuroepidemiology.

[18]  T. Seeman,et al.  Urban neighborhood context, educational attainment, and cognitive function among older adults. , 2006, American journal of epidemiology.

[19]  M. Albert,et al.  Benchmarks for designing two-stage studies using modified mini-mental state examinations: experience from the Women's Health Initiative Memory Study , 2006, Clinical trials.

[20]  Hiroko H Dodge,et al.  Depressive symptoms and cognitive decline in late life: a prospective epidemiological study. , 2006, Archives of general psychiatry.

[21]  A. D. Diez Roux,et al.  Associations of neighborhood characteristics with the location and type of food stores. , 2006, American journal of public health.

[22]  M. Winkleby,et al.  Protective and harmful effects of neighborhood-level deprivation on individual-level health knowledge, behavior changes, and risk of coronary heart disease. , 2005, American journal of epidemiology.

[23]  Ming Wen,et al.  Racial disparities in self-rated health at older ages: what difference does the neighborhood make? , 2005, The journals of gerontology. Series B, Psychological sciences and social sciences.

[24]  Ana V Diez Roux,et al.  The association of personal and neighborhood socioeconomic indicators with subclinical cardiovascular disease in an elderly cohort. The cardiovascular health study. , 2004, Social science & medicine.

[25]  L. Bäckman,et al.  Multiple cognitive deficits during the transition to Alzheimer's disease , 2004, Journal of internal medicine.

[26]  Nancy E Adler,et al.  Local services and amenities, neighborhood social capital, and health. , 2004, Social science & medicine.

[27]  L. Thal,et al.  Conjugated equine estrogens and global cognitive function in postmenopausal women: Women's Health Initiative Memory Study , 2004, JAMA.

[28]  Kristina Sundquist,et al.  Neighborhood socioeconomic environment and incidence of coronary heart disease: a follow-up study of 25,319 women and men in Sweden. , 2004, American journal of epidemiology.

[29]  Andrew Steptoe,et al.  How neighborhoods and physical functioning are related: The roles of neighborhood socioeconomic status, perceived neighborhood strain, and individual health risk factors , 2004, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[30]  A Hofman,et al.  Effect of smoking on global cognitive function in nondemented elderly , 2004, Neurology.

[31]  N. Wainwright,et al.  Places, people, and their physical and mental functional health , 2004, Journal of Epidemiology and Community Health.

[32]  S. Johansson,et al.  Neighbourhood deprivation and incidence of coronary heart disease: a multilevel study of 2.6 million women and men in Sweden , 2003, Journal of epidemiology and community health.

[33]  Susan R. Johnson,et al.  The Women's Health Initiative postmenopausal hormone trials: overview and baseline characteristics of participants. , 2003, Annals of epidemiology.

[34]  I. Kawachi,et al.  Social capital and neighborhood mortality rates in Chicago. , 2003, Social science & medicine.

[35]  G. Elder,et al.  Linking early social risks to impaired physical health during the transition to adulthood. , 2003, Journal of health and social behavior.

[36]  R. Sampson,et al.  ASSESSING "NEIGHBORHOOD EFFECTS": Social Processes and New Directions in Research , 2002 .

[37]  L. Fratiglioni,et al.  Predictors of cognitive change from preclinical to clinical Alzheimer's disease. , 2002, Brain and cognition.

[38]  M. Siahpush,et al.  Increasing inequalities in all-cause and cardiovascular mortality among US adults aged 25-64 years by area socioeconomic status, 1969-1998. , 2002, International journal of epidemiology.

[39]  A. Roux Investigating Neighborhood and Area Effects on Health , 2001 .

[40]  Robert D. Langer,et al.  Short version of the CES-D (Burnam screen) for depression in reference to the structured psychiatric interview , 2001, Psychiatry Research.

[41]  C. Ross,et al.  Neighborhood disadvantage, disorder, and health. , 2001, Journal of health and social behavior.

[42]  R. Bland,et al.  Mild Dementia or Cognitive Impairment: The Modified Mini-Mental State Examination (3MS) as a Screen for Dementia , 2001, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[43]  J. Jackson,et al.  Neighborhood disadvantage, stress, and drug use among adults. , 2001, Journal of health and social behavior.

[44]  R. Palmer,et al.  Ethnic Differences in Mini‐Mental State Examination (MMSE) Scores: Where You Live Makes a Difference , 2001, Journal of the American Geriatrics Society.

[45]  Domenico Inzitari,et al.  Cognitive Impairment Without Dementia in Older People: Prevalence, Vascular Risk Factors, Impact on Disability. The Italian Longitudinal Study on Aging , 2000, Journal of the American Geriatrics Society.

[46]  M A Espeland,et al.  The Women's Health Initiative Memory Study (WHIMS): a trial of the effect of estrogen therapy in preventing and slowing the progression of dementia. , 1998, Controlled clinical trials.

[47]  C. Napoli,et al.  Congestive Heart Failure and Cognitive Impairment in an Older Population , 1998 .

[48]  J Bound,et al.  Use of census-based aggregate variables to proxy for socioeconomic group: evidence from national samples. , 1998, American journal of epidemiology.

[49]  S. Robert Community-level socioeconomic status effects on adult health. , 1998, Journal of health and social behavior.

[50]  F. LeClere,et al.  Ethnicity and Mortality in the United States: Individual and Community Correlates , 1997 .

[51]  G W Comstock,et al.  Neighborhood environments and coronary heart disease: a multilevel analysis. , 1997, American journal of epidemiology.

[52]  I McDowell,et al.  Community screening for dementia: the Mini Mental State Exam (MMSE) and Modified Mini-Mental State Exam (3MS) compared. , 1997, Journal of clinical epidemiology.

[53]  P. Sorlie,et al.  Mortality Effects of Community Socioeconomic Status , 1997, Epidemiology.

[54]  Kelvyn Jones,et al.  Individuals and their ecologies: analysing the geography of chronic illness within a multilevel modelling framework , 1995 .

[55]  T. Tombaugh,et al.  The Mini‐Mental State Examination: A Comprehensive Review , 1992, Journal of the American Geriatrics Society.

[56]  H. Chui,et al.  The Modified Mini-Mental State (3MS) examination. , 1987, The Journal of clinical psychiatry.

[57]  M. Haan,et al.  Poverty and health: Prospective evidence for the Alameda County Study , 1987 .

[58]  L. Robins,et al.  National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. , 1981, Archives of general psychiatry.

[59]  T. Seeman,et al.  Urban neighborhoods and depressive symptoms among older adults. , 2007, The journals of gerontology. Series B, Psychological sciences and social sciences.

[60]  Trevillore E. Raghunathan,et al.  IVEware: Imputation and Variance Estimation Software User Guide , 2002 .

[61]  M. Albert,et al.  Social relationships, social support, and patterns of cognitive aging in healthy, high-functioning older adults: MacArthur studies of successful aging. , 2001, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[62]  A. D. Diez Roux,et al.  Investigating neighborhood and area effects on health. , 2001, American journal of public health.

[63]  S. Syme,et al.  The social environment and health: a discussion of the epidemiologic literature. , 1999, Annual review of public health.

[64]  C. Napoli,et al.  Congestive heart failure and cognitive impairment in an older population. Osservatorio Geriatrico Campano Study Group. , 1998, Journal of the American Geriatrics Society.

[65]  C. Sherbourne,et al.  The MOS social support survey. , 1991, Social science & medicine.

[66]  D. A. Kenny,et al.  The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. , 1986, Journal of personality and social psychology.