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标题：Neighborhood Socioeconomic Status and Cognitive Function in Women
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作者：Regina A. Shih ; Bonnie Ghosh-Dastidar ; Karen L. Margolis 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2011
卷号：101
期号：9
页码：1721-1728
DOI：10.2105/AJPH.2011.300169
语种：English
出版社：American Public Health Association
摘要：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. A growing body of research suggests that the characteristics of neighborhoods in which individuals live may influence their risk of poor self-rated health, cardiovascular disease, and mortality above and beyond individual-level characteristics.^{1 – 15} The proposed mechanisms by which lower quality neighborhoods may affect physical health include increased exposure to chronic stressors and pollutants in the environment; increased access to alcohol and cigarette outlets; barriers to physical activity; reduced social support, networks, and cohesion; and reduced access to high-quality health and social services. Three recent studies have linked lower neighborhood socioeconomic status (NSES) to lower cognitive function in UK adults older than 52 years,¹⁶ US adults older than 70 years living in urban areas,¹⁷ and Mexican Americans older than 65 years living in 5 southwestern states.¹⁸ However, the mechanisms underlying this relationship are not well understood. Extensive epidemiological research has linked NSES to vascular-related conditions,^{4 , 19 – 22} poor health behaviors,^{23 – 25} and greater psychosocial stress.^{26 – 30} Incidentally, these factors also have well-established linkages with brain health such that individuals who have vascular-related conditions,^{31 , 32} who engage in low levels of physical activity, whose tobacco and alcohol consumption is excessive,^{33 – 35} and who have pronounced symptoms of depression or low social support^{36 – 38} are at increased risk for poor cognitive function. No studies to date have addressed whether these conditions may explain the relationship between NSES and cognitive function. Previous studies indicate that neighborhood environments may influence poor cognitive function above and beyond individual-level demographic characteristics such as age, race/ethnicity, educational attainment, and income.^{16 , 17 , 39 , 40} Certain demographic subgroups may be especially vulnerable to the effects of NSES on cognitive function. For example, poor neighborhood environments may have stronger effects on older adults than on younger adults because older adults spend more time in their neighborhoods⁴¹; may have less access to social, financial, or health services; and have accumulated more exposures to stressors or pollutants. Non-White older adults who live in lower socioeconomic status (SES) neighborhoods may face discrimination or other stressors that may confer greater vulnerability to NSES effects on cognitive function. Wight et al.¹⁷ examined individual- and neighborhood-level educational interactions among US adults. However, no US study to date has addressed whether other individual-level demographic factors may buffer or exacerbate the negative effects on cognitive function of living in a lower SES neighborhood using an index consisting of important measures of SES beyond education alone. We examined whether an NSES index was related to cognitive function in a large, geographically and demographically diverse cohort of older US women with rich data on a sensitive measure of global cognitive function and a comprehensive set of clinical, behavioral, and psychosocial confounders. In addition, we assessed whether the relationship between NSES and cognitive function was explained by risk and protective factors for poor cognitive function that have also been linked with NSES and whether certain subgroups were more vulnerable to lower NSES.