Gender-Based Pathways to Cognitive Aging in the Mexican-Origin Population in the United States: The Significance of Work and Family

Abstract

Objectives This study uses the life course perspective to explore the role of key mid-life factors (occupation and number of children) for gender- and nativity-based pathways to cognitive aging for older Mexican Americans. Methods Using the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE, 1993/1994-2016, n=2,779), this study presents (a) cognitive impairment trajectories over 20 years of data and (b) multinomial logistic regression analyses of trajectory group membership by lifetime occupation and number of children, controlling for educational attainment. Results For older Mexican American men, lifetime employment in agricultural occupations is associated with elevated risk for late life cognitive impairment. Delayed risk for impairment is observed for U.S.-born men who were employed in factory work (e.g., production and repair) and in Mexican-born men who were employed in occupations with skilled or supervisory requirements. For all women, labor force participation, especially in skilled occupations, is related to a delayed risk of cognitive impairment. Number of children is unrelated to impairment for men; however, women with five or more children (compared to women with two to four children) are at risk for consistent and rapid cognitive impairment in late life. Discussion Late life cognitive health disparities that disproportionately impact the Mexican American population can be addressed by improving access to educational and occupational opportunities in early and mid-life. This study points to key areas of intervention within work and the home for the Mexican-origin population.

Associations Between Parity and Cognition: Race/Ethnic Differences

“…In contrast to the literature on ADRD, evidence for the association between parity and cognition is more inconsistent, with some studies reporting that higher parity is associated with worse cognition [25][26][27], some reporting the opposite (i.e., higher parity is associated with better cognition) [28], and others reporting no significant associations [29]. Mental status (e.g., scores on the Mini-Mental State Exam [MMSE]) has repeatedly been associated with cognition: evidence of a detrimental effect of parity was detected in a large Chinese and smaller American cohort [27,30], yet in the Women's Health Study higher parity was associated with better mental status [28].…”

“…To our knowledge, few studies have included Latinas and NLB women in their samples and none have explored the moderating effect of race/ethnicity in the parity and cognition association. Among women of Mexican heritage living in the United States and Mexico, parity has a more consistently detrimental association with cognition compared to more mixed findings for the parity and cognition association among NLW and Asian women [25,26]. Namely, Saenz et al [26] utilized the data of 11,380 Mexican men and women from the Mexican Health and Aging Study to examine the association between number of children and cognitive functioning.…”

Mitochondrial DNA oxidative mutations are elevated in Mexican American women potentially implicating Alzheimer’s disease

“…Fletcher et al reported associations between educational attainment and cognition in older age, after controlling for family background and genetic factors, and an interaction demonstrating those with an increased risk for AD mildly benefit from a higher educational background 44 . Educational attainment has been moderately studied in MAs with evidence indicating the disparity in cognitive impairment and dementia is due to genetic, behavioral, and socioeconomic factors 45 . Socioeconomic factors were found to be especially important in the disparity, highlighting the inequity in educational attainment among underrepresented or immigrant populations that may contribute to their risk for cognitive decline 46 .…”

Duration of Dementia and Social Service Use in the U.S.-Born and Foreign-Born Mexican-American Population

“…This is a profile consistent with lower cognitive reserve and higher dementia risk (Garcia et al, 2019; Downer, Garcia, Saenz, 2017). Occupations requiring more education serve to promote cognitive functioning with aging, especially for Mexican-American women (Rote & Angel, 2021).…”

“…Women use dementia services more often than men and low education decreases use of dementia care services (Villa & Aranda, 2000). Access to services is affected by both marital status and caregiver employment status (Rote & Angel, 2021). High levels of acculturation (nativity, language of interview and duration of time spent in the United States) increase the likelihood of formal care (Angel et al, 2016).…”