Lagged Associations of Metropolitan Statistical Area- and State-Level Income Inequality with Cognitive Function: The Health and Retirement Study

TitleLagged Associations of Metropolitan Statistical Area- and State-Level Income Inequality with Cognitive Function: The Health and Retirement Study
Publication TypeJournal Article
Year of Publication2016
AuthorsKim, D, Griffin, BAnn, Kabeto, MU, Escarce, J, Langa, KM, Shih, RA
Secondary AuthorsGlymour, MM
JournalPLOS ONE
Volume11
Issue6
Paginatione0157327
Date PublishedOct-06-2017
KeywordsIncome, Mortality, Socioeconomic factors
Abstract

Purpose

Much variation in individual-level cognitive function in late life remains unexplained, with little exploration of area-level/contextual factors to date. Income inequality is a contextual factor that may plausibly influence cognitive function.

Methods

In a nationally-representative cohort of older Americans from the Health and Retirement Study, we examined state- and metropolitan statistical area (MSA)-level income inequality as predictors of individual-level cognitive function measured by the 27-point Telephone Interview for Cognitive Status (TICS-m) scale. We modeled latency periods of 8–20 years, and controlled for state-/metropolitan statistical area (MSA)-level and individual-level factors.

Results

Higher MSA-level income inequality predicted lower cognitive function 16–18 years later. Using a 16-year lag, living in a MSA in the highest income inequality quartile predicted a 0.9-point lower TICS-m score (β = -0.86; 95% CI = -1.41, -0.31), roughly equivalent to the magnitude associated with five years of aging. We observed no associations for state-level income inequality. The findings were robust to sensitivity analyses using propensity score methods.

Conclusions

Among older Americans, MSA-level income inequality appears to influence cognitive function nearly two decades later. Policies reducing income inequality levels within cities may help address the growing burden of declining cognitive function among older populations within the United States.

URLhttp://dx.doi.org/10.1371/journal.pone.0157327
DOI10.1371/journal.pone.0157327
Short TitlePLoS ONE
Citation Key8542
PubMed ID27332986
PubMed Central IDPMC4917220