Associations between education and dementia in the Caribbean and the United States: An international comparison

Abstract

Introduction Despite high dementia prevalence in Hispanic populations globally, especially Caribbean Hispanics, no study has comparatively examined the association between education and dementia among Hispanics living in the Caribbean Islands and older adults in the United States. Methods We used data on 6107 respondents aged 65 and older in the baseline wave of the population‐based and harmonized 10/66 survey from Cuba, the Dominican Republic, and Puerto Rico, collected between 2003 and 2008, and 11,032 respondents aged 65 and older from the U.S.‐based Health and Retirement Study data in 2014, a total of 17,139 individuals. We estimated multivariable logistic regression models examining the association between education and dementia, adjusted for age, income, assets, and occupation. The models were estimated separately for the Caribbean population (pooled and by setting) and the U.S. population by race/ethnicity (Hispanic, Black, and White), followed by pooled models across all populations Results In the Caribbean population, the relative risk of dementia among low versus high educated adults was 1.45 for women (95% confidence interval [CI] 1.17, 1.74) and 1.92 (95% CI 1.35, 2.49) for men, smaller compared to those in the United States, especially among non‐Hispanic Whites (women: 2.78, 95% CI 1.94, 3.61; men: 5.98, 95% CI 4.02, 7.95). Discussion The differential associations between education and dementia across the Caribbean and US settings may be explained by greater disparities in social conditions in the United States compared to the Caribbean, such as access to health care, healthy behaviors, and social stressors, which serve as potentially important mediators.

Apolipoprotein E (APOE) genotype, dementia, and memory performance among Caribbean Hispanic versus US populations

“…In particular, education level and quality of education may explain differences in dementia prevalence across populations. 29,50,51 The present study is not without limitations, and several aspects of our research need to be kept in mind when interpreting these results. First, the classification procedure for assigning dementia status and cognitive assessment differed in the HRS and 10/66, which could influence the comparability of our risk estimations between dementia and APOE status.…”

“…Dementia diagnosis was established following: (1) a structured clinical interview; (2) a cognitive test battery including (a) the Community Screening Instrument for Dementia (CSI‐D), 27 (b) a verbal fluency task, and (c) the modified Consortium to Establish a Registry for Alzheimer's Disease 10 word list learning task with delayed recall; 28 and (3) an informant interview (CSI‐D) 27 for evidence of cognitive and functional decline. This dementia measure has been previously used 29 for cross‐national comparisons to the Langa‐Weir dementia measure in the US HRS.…”

“…Age was ascertained using documented age, or an event calendar as provided by participant or informant report. Educational attainment was measured differently between 10/66 and the HRS, due in part to contextual differences across regions, following the approach of prior research 29 . For 10/66 respondents, we categorized educational attainment as (1) not completing primary school, (2) completed primary school, or (3) secondary school or above.…”

“…25,26 27 for evidence of cognitive and functional decline. This dementia measure has been previously used 29 for cross-national comparisons to the Langa-Weir dementia measure in the US HRS.…”

“…Educational attainment was measured differently between 10/66 and the HRS, due in part to contextual differences across regions, following the approach of prior research. 29 For 10/66 respondents, we categorized educational attainment as ( 1) not completing primary school, (2) completed primary school, or (3) secondary school or above. For HRS respondents, we categorized educational attainment as (1) no high school degree, (2) high school degree or equivalent, or (3) some college or above.…”