Introduction
This is a nationally representative study of rural−urban disparities in the prevalence
of probable dementia and cognitive impairment without dementia (CIND).
Methods
Data on non-institutionalized U.S. adults from the 2000 (n=16,386) and 2010 (n=16,311) cross-sections of the Health and Retirement Study were linked to respective
Census assessments of the urban composition of residential census tracts. Relative
risk ratios (RRR) for rural−urban differentials in dementia and CIND respective to
normal cognitive status were assessed using multinomial logistic regression. Analyses
were conducted in 2016.
Results
Unadjusted prevalence of dementia and CIND in rural and urban tracts converged so
that rural disadvantages in the relative risk of dementia (RRR=1.42, 95% CI=1.10,
1.83) and CIND (RRR=1.35, 95% CI=1.13, 1.61) in 2000 no longer reached statistical
significance in 2010. Adjustment for the strong protective role of educational attainment
reduced rural disadvantages in 2000 to statistical nonsignificance, whereas adjustment
for race/ethnicity resulted in a statistically significant increase in RRRs in 2010.
Full adjustment for sociodemographic and health factors revealed persisting rural
disadvantages for dementia and CIND in both periods with RRR in 2010 for dementia
of 1.79 (95% CI=1.31, 2.43) and for CIND of 1.38 (95% CI=1.14, 1.68).
Conclusions
Larger gains in rural adults’ cognitive functioning between 2000 and 2010 that are
linked with increased educational attainment demonstrate long-term public health benefits
of investment in secondary education. Persistent disadvantages in cognitive functioning
among rural adults compared with sociodemographically similar urban peers highlight
the importance of public health planning for more rapidly aging rural communities.
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Article info
Publication history
Published online: December 12, 2017
This activity is available for CME credit. See page A3 for information.Identification
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© 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
