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Mother’s education and late-life disparities in memory and dementia risk among US military veterans and non-veterans
  1. Anusha M Vable1,2,3,4,
  2. Chloe W Eng4,
  3. Elizabeth Rose Mayeda5,
  4. Sanjay Basu1,2,6,
  5. Jessica R Marden7,
  6. Rita Hamad3,8,
  7. M Maria Glymour4,9
  1. 1 Center for Population Health Sciences, Stanford University, Palo Alto, California, USA
  2. 2 Center for Primary Care and Outcomes Research, Stanford University, Palo Alto, California, USA
  3. 3 Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
  4. 4 Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
  5. 5 Department of Epidemiology, University of California, Los Angeles, Los Angeles, California, USA
  6. 6 Center for Primary Care, Harvard Medical School, Boston, Massachusetts, USA
  7. 7 Analysis Group, Cambridge, Massachusetts, USA
  8. 8 Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, USA
  9. 9 Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Anusha M Vable, Department of Family and Community Medicine, University of California, San Francisco, CA 94063, USA; anusha.vable{at}ucsf.edu

Abstract

Background Adverse childhood socioeconomic status (cSES) predicts higher late-life risk of memory loss and dementia. Veterans of U.S. wars are eligible for educational and economic benefits that may offset cSES disadvantage. We test whether cSES disparities in late-life memory and dementia are smaller among veterans than non-veterans.

Methods Data came from US-born men in the 1995–2014 biennial surveys of the Health and Retirement Study (n=7916 born 1928–1956, contributing n=38 381 cognitive assessments). Childhood SES was represented by maternal education. Memory and dementia risk were assessed with brief neuropsychological assessments and proxy reports. Military service (veteran/non-veteran) was evaluated as a modifier of the effect of maternal education on memory and dementia risk. We employed linear or logistic regression models to test whether military service modified the effect of maternal education on memory or dementia risk, adjusted for age, race, birthplace and childhood health.

Results Low maternal education was associated with worse memory than high maternal education (β = −0.07 SD, 95% CI −0.08 to –0.05), while veterans had better memory than non-veterans (β = 0.03 SD, 95% CI 0.02 to 0.04). In interaction analyses, maternal education disparities in memory were smaller among veterans than non-veterans (difference in disparities = 0.04 SD, 95% CI 0.01 to 0.08, p = 0.006). Patterns were similar for dementia risk.

Conclusions Disparities in memory by maternal education were smaller among veterans than non-veterans, suggesting military service and benefits partially offset the deleterious effects of low maternal education on late-life cognitive outcomes.

  • dementia
  • health inequalities
  • life course epidemiology
  • social epidemiology
  • socio-economic

https://doi.org/10.1136/jech-2018-210771

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    Footnotes

    • Contributors AMV, ERM, SB and MMG conceptualised the study. AMV led the data analysis, interpreted the results and wrote the first draft of the paper. CWE, ERM and JRM contributed to the data analysis and interpretation. AMV, ERM, SB, RH and MMG contributed to the framing of the manuscript. All authors reviewed and approved the final manuscript.

    • Funding Research reported in this publication was supported by the Stanford Center on the Demography and Economics of Health and Aging pilot grants program (AMV), under a parent award from the National Institute on Aging under Award Number AG017253 (Bhattacharya), the National Institute on Minority Health And Health Disparities under Award Number DP2MD010478 (SB) and the National Institute on Aging under Award Number K99AG053410 (ERM).

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.