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Aging Ment Health. 2019 Apr 25:1-8. doi: 10.1080/13607863.2019.1594169. [Epub ahead of print]

The association between neighborhood socioeconomic status, cardiovascular and cerebrovascular risk factors, and cognitive decline in the Health and Retirement Study (HRS).

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a Department of Biostatistics and Bioinformatics , Duke University Medical Center , Durham , NC , USA.
b Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , NC , USA.
c Department of Social Sciences and Health Policy , Wake Forest School of Medicine , Winston-Salem , NC , USA.
d Department of Neurology , Duke University Medical Center , Durham , NC , USA.
e Department of Biostatistical Sciences , Wake Forest School of Medicine , Winston-Salem , NC , USA.



A small but growing body of evidence supports a relationship between neighborhood socioeconomic status (NSES) and cognitive decline. Additional work is needed to characterize this relationship controlling for risk factors such as cardiovascular, cerebrovascular, and genetic risk factors.


Cognitive decline was assessed in association with NSES, and cardiovascular and cerebrovascular risk factors (heart disease, diabetes, hypertension, and stroke) in 8,198 individuals from the 1992-2010 waves of the Health and Retirement Study (HRS). Latent class trajectory analysis determined the number of cognitive trajectory classes that best fit the data, and a multinomial logistic regression model in the latent class framework assessed the risk for cognitive classes conferred by NSES index score and heart disease, diabetes, hypertension, and stroke across three trajectory classes of cognitive function. The analyses controlled for genetic risk for cognitive decline (including APOE genotype) and demographic variables, including education.


The HRS sample was 57.6% female and 85.5% White, with a mean age of 67.5(3.5) years at baseline. The three-quadratic-class model best fit the data, where higher classes represented better cognitive function. Those with better cognitive function were mainly younger white females. Those in the highest quartile of NSES had 57% higher odds of being in the high cognitive function class. Heart disease, diabetes, hypertension, and stroke each increased the odds having of lower cognitive function.


In examining the relationship of cognitive status with various variables, neighborhood socioeconomic status, cardiovascular risk, and cerebrovascular risk persisted across the cognitive trajectory classes.


APOE; Cognition; NSES; risk factors

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