Neighborhood Deprivation, Individual Socioeconomic Status, and Cognitive Function in Older People: Analyses from the English Longitudinal Study of Ageing

Abstract

OBJECTIVES-To assess the relationship between cognitive function, socioeconomic status, and neighborhood deprivation (lack of local resources of all types, financial and otherwise). DESIGN-Nationally representative cross-section. SETTING-The English Longitudinal Study of Ageing (ELSA).PARTICIPANTS-Seven thousand one hundred twenty-six community-dwelling individuals aged 52 and older and resident in urban areas.MEASUREMENTS-Individual cognitive function score and index of multiple deprivation (IMD) at the Super Output Area level, adjusting for health, lifestyle, and sociode-mographic confounders. Analyses were conducted separately according to sex and age group (52-69 and ≥70).RESULTS-IMD affected cognitive function independent of the effects of education and socioeconomic status. For example, in fully adjusted models, women aged 70 and older had a standardized cognitive function score (z-score) that was 0.20 points (95% confidence interval (CI) = 0.01-0.39) lower in the bottom 20% of wealth than the top 20%, 0.44 points (95% CI = 0.20-0.69) lower in the least-educated group than in the most educated, and 0.31 points (95% CI 0.15-0.48) lower if resident lived in an area in the bottom 20% of IMD than in the top 20%.CONCLUSION-In community-based older people in urban neighborhoods, neighborhood deprivation-living in a neighborhood with high levels of deprivation, compared with national levels Address correspondence to Dr. Iain Lang, Epidemiology & Public Health Group, Peninsula Medical School, RD&E Wonford Site, Barrack Road, Exeter EX2 5DW, UK. E-mail: E-mail: iain.lang@pms.ac.uk. The characteristics of the places people inhabit influence many aspects of their health and wellbeing. Living in a deprived neighborhood has been shown to be associated with risky health behaviors, 1 poor cardiovascular health, 2 higher mortality, 3 and greater depression. 4 Various mechanisms to account for neighborhood effects on health have been proposed, including access to resources such as primary care and stores selling healthy food 5,6 and relationships with the built environment. 7,8 Conflict of NIH Public AccessOlder people are at heightened risk of being affected by such neighborhood effects, 9 and mental health 10,11 and physical function 12,13 have been found to be poorer in older people living in deprived urban neighborhoods. Previous studies also suggest a relationship between neighborhood characteristics and cognitive function in older adults, indicating that differences between neighborhoods explain ethnic differences in Mini-Mental State Examination (MMSE) scores 14 and that there is a relationship between mean levels of educational attainment in U.S. census tracts and the cognitive status of adults aged 70 and older living in them. 15 Cognitive function is known to be associated with level of education 16 and with socioeconomic status, including wealth and income, 17-19 but an association between neighborhood socioeconomic factors and cognitive function additional to the effect of individual circumstances has ...

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“…Similar results were observed in population studies of the elderly in Asia (> 60 years) 11 , of British adults and elderly (> 50 years) 13 and of the American elderly (> 65 years) 12 , in which neighborhoods with low income and educational levels, higher unemployment and sources of public assistance were associated with cognitive decline. Similarly, institutionalized elderly people in Britain (> 65 years) living in neighborhoods with a higher deprivation index were twice as likely to experience cognitive decline compared to areas with less deprivation, regardless of individual education or social class 29 .…”

“…Studies carried out in Asia 11 , North America 12 and Europe 13 have found that elderly people who lived in neighborhoods with worse socioeconomic indicators, such as lower income or education level and higher unemployment, had lower cognitive performance scores regardless of individual socioeconomic factors.…”

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“…The importance of the built environment for successful aging is stressed by the results of a British longitudinal study showing that living in a deprived neighbourhood is associated with cognitive decline independent of socio-economic factors (Lang et al, 2008) and a recent US study indicating that walkable neighbourhoods can mitigate cognitive decline (Watts et al, 2014).…”

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