Childhood deprivation and later-life cognitive function in a population-based study of older rural South Africans. (October 2017)

• Record Type: Journal Article
• Authors: Kobayashi, Lindsay C.; Glymour, M. Maria; Kahn, Kathleen; Payne, Collin F.; Wagner, Ryan G.; Montana, Livia; Mateen, Farrah J.; Tollman, Stephen M.; Berkman, Lisa F.
• Is Part Of: Social science & medicine. Volume 190(2017)
• Page Start: 20
• Page End: 28
• Publication Date: 2017-10
• Subjects: South Africa -- Rural -- Aging -- Cognitive aging -- Cognitive function -- Education -- Socioeconomic conditions -- Self-rated health; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2017.08.009
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: Rationale: Little research has evaluated the life course drivers of cognitive aging in South Africa. Objectives: We investigated the relationships of self-rated childhood health and father's occupation during childhood with later-life cognitive function score and whether educational attainment mediated these relationships among older South Africans living in a former region of Apartheid-era racial segregation. Methods: Data were from baseline assessments of "Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community" (HAALSI), a population-based study of 5059 men and women aged ≥40 years in 2015 in rural Agincourt sub-district, South Africa. Childhood health, father's occupation during childhood, and years of education were self-reported in study interviews. Cognitive measures assessed time orientation, numeracy, and word recall, which were included in a z-standardized latent cognitive function score variable. Linear regression models adjusted for age, sex, and country of birth were used to estimate the total and direct effects of each childhood risk factor, and the indirect effects mediated by years of education. Results: Poor childhood health predicted lower cognitive scores (total effect = −0.28; 95% CI = −0.35, −0.21, versus good); this effect was not mediated by educational attainment. Having a father in a professional job during childhood, while rare (3% of sample), predicted better cognitive scores (total effect = 0.25; 95% CI = 0.10, 0.40, versus unskilled manual labor, 29% of sample). Half of this effect was mediated by educational attainment. Education was linearly associated with later-life cognitive function score (0.09; 95% CI = 0.09, 0.10 per year achieved). Conclusion: In this post-Apartheid, rural South African context, older adults with poor self-reported childhood health or whose father worked in unskilled manual labor had relatively poor cognitive outcomes. Educational attainment strongly predicted cognitive outcomes, and appeared to be, in part, a mechanism of social stratification in later-life cognitive health in this context. Highlights: Among the first studies of life-course drivers of cognitive aging in South Africa. Research focuses on a population that lived under Apartheid through midlife. Childhood health predicted later-life cognitive health, not mediated by education. Father's occupation predicted later-life cognitive health, mediated by education. Early-life social stratification key to later-life cognition in this population.