%0 Journal Article %J The Journal of Gerontology, Series A %D 2023 %T Associations between Change in Kidney Functioning, Age, Race/ethnicity and Health Indicators in the Health and Retirement Study. %A Zhao, Erfei %A Jennifer A Ailshire %A Jung K Kim %A Wu, Qiao %A Crimmins, Eileen M %K Cystatin C %K Kidney function %K Metabolism %X

BACKGROUND: The aging process is accompanied by decline in kidney functioning. It remains unknown to what extent age-related decline in kidney functioning can be attributed to health indicators, and whether rate of decline differs across sociodemographic groups.

METHODS: Using data from the Health and Retirement Study from 2006/2008 through 2014/2016, we estimated kidney functioning trajectories, determined by cystatin C, among adults aged over 51 over 8-year. We evaluated the role of age, health conditions/behaviors, and genetics in the decline and also examined sociodemographic differentials.

RESULTS: Kidney function declined with age and accelerated at older ages, even after adjusting for health conditions/behaviors and genetic differences (e.g., 0.019 mg/L annual increase in cystatin C among 70-79 compared to 0.007 mg/L among 52-59 at baseline). Decline occurred faster among those with uncontrolled diabetes (0.008, p=0.009), heart conditions (0.007, p<0.000), and obesity (0.005, p=0.033). Hispanic participants (0.007, p=0.039) declined faster than non-Hispanic White persons due to diabetes, heart conditions, and obesity; non-Hispanic Black participants had worse baseline kidney functioning (0.099, p<0.000), but only one-fourth of this Black-White difference was explained by investigated risk factors. People with higher education experienced slower decline (-0.009, p=0.004).

CONCLUSIONS: Age was a significant predictor of decline in kidney functioning, and its association was not fully explained by health conditions/behaviors, or genetics. Better management of diabetes, heart conditions, and obesity is effective in slowing this decline. Baseline differences in kidney functioning (e.g., between non-Hispanic White and Black persons; those with and without hypertension) suggest disparities occur early in the life course and require early interventions.

%B The Journal of Gerontology, Series A %V 78 %P 2094-2104 %G eng %N 11 %R 10.1093/gerona/glad204 %0 Journal Article %J PLoS One %D 2023 %T Inequality in housing transitions during cognitive decline. %A Mawhorter, Sarah L %A Wilkie, Rachel Z %A Jennifer A Ailshire %K Caregivers %K Cognitive Dysfunction %K Dementia %K Housing %K Humans %K Nursing homes %K Quality of Life %K United States %X

Independent living can become challenging for people experiencing cognitive decline. With reduced functioning and greater care needs, many people with dementia (PWD) may need to move to another home with better safety features, move to live closer to or with relatives who can provide care, or enter a nursing home. Housing plays a key role in supporting quality of life for both PWD and their caregivers, so the ability to move when needed is crucial for their well-being. Yet the substantial costs of moving, housing, and care mean that PWD with limited financial resources may be unable to afford moving, exacerbating inequalities between more and less advantaged PWD. Emerging qualitative research considers the housing choices of PWD and their caregivers, yet little is known on a broader scale about the housing transitions PWD actually make over the course of cognitive decline. Prior quantitative research focuses specifically on nursing home admissions; questions remain about how often PWD move to another home or move in with relatives. This study investigates socioeconomic and racial/ethnic disparities in the timing and type of housing transitions among PWD in the United States, using Health and Retirement study data from 2002 through 2016. We find that over half of PWD move in the years around dementia onset (28% move once, and 28% move twice or more) while 44% remain in place. Examining various types of moves, 35% move to another home, 32% move into nursing homes, and 11% move in with relatives. We find disparities by educational attainment and race/ethnicity: more advantaged PWD are more likely to move to another home and more likely to enter a nursing home than less advantaged groups. This highlights the importance of providing support for PWD and their families to transition into different living arrangements as their housing needs change.

%B PLoS One %V 18 %P e0282329 %G eng %N 4 %R 10.1371/journal.pone.0282329 %0 Journal Article %J Population Research and Policy Review %D 2023 %T Race, gender, and cohort differences in the educational experiences of Black and White Americans %A Walsemann, Katrina M. %A Fisk, Calley E. %A Farina, Mateo P. %A Abbruzzi, Emily %A Jennifer A Ailshire %K Educational experiences %K life course %K life history %K Schools %X Federal legislation and judicial intervention led to significant transformation in the U.S. education system during the early to mid-twentieth century. These changes may differentiate older adults in their experiences of aging, particularly at the intersection of race, gender, and cohort, but are not well documented among current cohorts of older adults. Our study addresses this gap by providing rich, descriptive information on the educational experiences of U.S. adults who attended primary or secondary school between 1915 and 1977. We used data from the Health and Retirement Study (HRS), a nationally representative, prospective study of U.S. adults over age 50 years. The HRS collected information on respondents’ schooling history and experiences through a Life History Mail Survey (LHMS). We restricted our sample to age-eligible HRS-LHMS respondents who self-identified as non-Hispanic White or non-Hispanic Black and completed at least 75% of their primary or secondary schooling in the U.S. (n = 10,632). Educational experiences, defined as pre-k to post-secondary education, varied across cohort, regardless of race or gender. Greater course offerings, improvements in learning support, and increasing exposure to integrated schools occurred across successive cohorts. We found the highest rates of enrollment in college preparatory curriculum and foreign-language courses as well as diagnosed learning differences in cohorts born after 1948. Among White adults, many of the gender differences in educational experiences documented in the oldest cohort were still found among the most recent cohort. Few gender differences, however, were found for Black adults regardless of cohort. Conversely, most race inequities in educational experiences persisted. Such inequities may be an important source of continued differences in experiences of aging observed across demographic groups. © 2023, The Author(s), under exclusive licence to Springer Nature B.V. %B Population Research and Policy Review %V 42 %G eng %R 10.1007/s11113-023-09831-w %0 Journal Article %J SSM - Population Health %D 2022 %T Black-White variation in the relationship between early educational experiences and trajectories of cognitive function among US-born older adults %A Katrina M. Walsemann %A Eleanor M. Kerr %A Jennifer A Ailshire %A Pamela Herd %K cognitive impairment %K Dementia %K Early Life %K Memory %K school segregation %X Black adults face a substantially higher risk for dementia in later life compared to their White peers. Given the critical role of educational attainment and cognitive function in later life dementia risk, this paper aims to determine if early educational experiences and educational attainment are differentially related to trajectories of cognitive status across race and if this further varies by education cohort. We use data from the Life History Mail Survey (LHMS) and prospective data on cognition from the Health and Retirement Study (HRS). We restrict our sample to Black and White US-born adults who provided at least one measure of cognitive status from 1995/6–2016. We find evidence of Black-White differences in the association between educational experiences and level of cognitive function, episodic memory, and working memory, but little evidence of Black-White differences in these associations with decline. Having a learning problem was associated with lower levels of cognitive function, episodic memory, and working memory for White and Black older adults, but was more strongly related to these outcomes among Black older adults. Further, the Black-White difference in this association was generally found in older cohorts that completed schooling after enactment of federal policies that improved educational resources for children with learning disabilities. Attending racially discordant schools was positively associated with level of these cognitive outcomes for Black older adults but not for White older adults. We also find that the educational gradient in level of cognitive function was larger for Black compared to White older adults in older cohorts not benefiting from the Brown v Board of Education decision but was similar for Black and White older adults attending school in the post-Brown era. %B SSM - Population Health %V 19 %P 101184 %G eng %R 10.1016/j.ssmph.2022.101184 %0 Journal Article %J Innovation in Aging %D 2022 %T DEVELOPMENT OF A FRAILTY INDEX FOR PEOPLE WITH DEMENTIA IN THE HEALTH AND RETIREMENT STUDY %A Wilkie, Rachel %A Jennifer A Ailshire %K Dementia %K frailty index %X Frailty indices (FI) have been found to predict adverse outcomes, such as, mortality, hospitalization, and institutionalization in older adults. However, traditional FIs often exclude people with dementia (PWD), who may not be able to consent to or complete all of the standard frailty items. While frailty is a known risk factor for onset of dementia and PWD have higher rates of frailty, little is known regarding how frailty predicts outcomes among PWD. Our study aims to develop an FI for PWD and to examine how this index relates to mortality, hospitalization, and nursing home stays. We used data from the Health and Retirement Study to create a 52-item FI for community-dwelling adults aged 50 years and over classified as having dementia (n = 1,107) in 2014. The index includes deficits in four domains: chronic health conditions, functional status, sensory problems, and overall health and wellbeing. A standardized FI score between 0 and 1 was calculated for each respondent. We used logistic regression to examine associations with FI and 2-year mortality, hospitalization, and nursing home stay, adjusting for age and gender. We found that a 0.1 unit increase in FI was significantly associated with higher odds of 2-year mortality (OR 1.39, p< 0.001), hospitalization (OR 1.45, p< 0.001), and nursing home stay (OR 1.38, p< 0.001) for people with dementia. This study developed an FI which is predictive for adverse outcomes among PWD. Future work should explore how socioeconomic and neighborhood factors contribute to the relationship between frailty and adverse outcomes among PWD. %B Innovation in Aging %V 6 %P 429 %G eng %N Suppl 1 %R 10.1093/geroni/igac059.1685 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Race inequity in school attendance across the Jim Crow South and its implications for Black-White disparities in trajectories of cognitive function among older adults. %A Katrina M Walsemann %A Urena, Stephanie %A Mateo P Farina %A Jennifer A Ailshire %K cognitive function %K Education %K historical data %K life course %K Racial Disparities %K school segregation %X

OBJECTIVES: Although education is a key determinant of cognitive function, its role in determining Black-White disparities in cognitive function is unclear. This may be due, in part, to data limitations that have made it difficult to account for systemic educational inequities in the Jim Crow South experienced by older cohorts, including differences in the number of days Black students attended school compared to their White counterparts or Black peers in better funded southern states. We determine if accounting for differential rates of school attendance across race, years, and states in the Jim Crow South better illuminates Black-White disparities in trajectories of cognitive function.

METHODS: We linked historical state-level data on school attendance from the 1919/20 to 1953/54 Biennial Surveys of Education to the Health and Retirement Study, a nationally representative, longitudinal study of U.S. adults over age 50. We restricted our sample to Black and White older adults who attended school in the Jim Crow South and began primary school in/after 1919/20 and completed primary/secondary school by 1953/1954 (n=4,343). We used linear mixed models to estimate trajectories of total cognitive function, episodic memory, and working memory.

RESULTS: Self-reported years of schooling explained 28-33% of the Black-White disparity in level of cognitive function, episodic memory, and working memory. Duration of school, a measure that accounted for differential rates of school attendance, explained 41-55% of the Black-White disparity in these outcomes.

DISCUSSION: Our study highlights the importance of using a more refined measure of schooling for understanding the education--cognitive health relationship.

%B The Journals of Gerontology, Series B %V 77 %P 1467-1477 %G eng %N 8 %R 10.1093/geronb/gbac026 %0 Journal Article %J SSM - Population Health %D 2022 %T Regional variation in U.S dementia trends from 2000-2012 %A Jennifer A Ailshire %A Katrina M. Walsemann %A Calley E. Fisk %K Dementia %K health trends %K Regional variation %X Although recent studies report a decline in dementia prevalence among U.S. older adults, national trends may mask subnational variation, particularly given large health and social inequalities linked to geography. To address this gap, we determined if there was subnational variation in reported national dementia trends and if region-specific trends were explained by sociodemographic and health characteristics. Data come from the 2000 (n = 10,447) and 2012 (10,426) waves of the Health and Retirement Study. We used validated methods for dementia classification using proxy and self-respondents. Logistic regression models, adjusted for within-person clustering over time, estimated trends in dementia prevalence by region and census division. We found subnational variation in dementia prevalence in both 2000 and 2012, as well as in change in dementia prevalence during this period. In 2000, dementia prevalence was lowest in the West (8.6%), higher in the Midwest (10.0%) and Northeast (11.1%), and highest in the South (14.6%). Dementia prevalence declined over time across all regions of the U.S. from 2000 to 2012 but remained highest in the South (10.7%) compared to the other regions (7.0–7.8%). Despite downward trends in dementia across the U.S., the prevalence of dementia in the South in 2012 approximated levels found in other regions in 2000. There was relatively less change over time in the West compared to other regions, but dementia prevalence was already quite low in the West in 2000. Within region, trends in dementia prevalence between 2000 and 2012 also varied slightly across census divisions. Subnational variation in changes in dementia prevalence were largely explained by education and health status. Variation in baseline prevalence, as well as differential rates of change, highlight the importance of examining subnational variation in dementia trends. %B SSM - Population Health %V 19 %P 101164 %G eng %R https://doi.org/10.1016/j.ssmph.2022.101164 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Religious Involvement and Cognitive Functioning at the Intersection of Race/Ethnicity and Gender in Mid-Life and Older Adults. %A Henderson, Andrea K %A Katrina M Walsemann %A Jennifer A Ailshire %K cognitive functioning %K gender %K race %K Religion %X

OBJECTIVES: To investigate the association between religious involvement and cognitive functioning at the intersections of race-ethnicity and gender among mid-life and older adults, and to determine if psychosocial factors help explain this relationship.

METHODS: The sample included 14,037 adults aged 50+ from the Health and Retirement Study (HRS). We utilized measures from the HRS 2010 and 2012 Core interviews and Leave Behind questionnaires and estimated our models using linear regression.

RESULTS: Compared to individuals who frequently attended religious services, infrequent religious service attendance was related to poorer cognitive functioning. Religiosity was inversely associated with cognitive functioning at baseline, but the relationship varied by race/gender subgroup. Greater religiosity was associated with better cognitive functioning among Black women, but lower cognitive functioning among White men and women. Psychosocial factors did little to explain the inverse association between religiosity and cognitive functioning.

DISCUSSION: Results suggest the association between religious involvement and cognitive functioning is varied and complex, and largely dependent on important social identities. The findings have important implications for investigating health-protective factors, like religious involvement, using an intersectional perspective.

%B The Journals of Gerontology, Series B %V 77 %P 237-248 %G eng %N 1 %R 10.1093/geronb/gbab034 %0 Journal Article %J The Journals of Gerontology, Series A %D 2021 %T Cardiometabolic Risk Trajectory among Older Americans: Findings from the Health and Retirement Study. %A Wu, Qiao %A Jennifer A Ailshire %A Jung K Kim %A Eileen M. Crimmins %K cardiovascular %K Change with age %K Medication %K Metabolism %X

BACKGROUND: Cardiometabolic risk (CMR) is a key indicator of physiological decline with age; but age-related declines in a nationally representative older U.S. population have not been previously examined.

METHODS: We examined the trajectory of cardiometabolic risk (CMR) over 8 years of aging, from 2006/2008 to 2014/2016, among 3,528 people over age 50 in the Health and Retirement Study. We used growth curve models to examine change in total CMR as well as in individual cardiometabolic biomarkers to understand how baseline differences and rates of change vary across sociodemographic characteristics, by smoking status, and medication use.

RESULTS: Total CMR did not change among respondents who survived over 8 years. Despite significant differences in CMR across demographic and education groups at baseline, the pace of change with age did not differ by these characteristics. Among individual biomarkers, risk levels of diastolic blood pressure, resting heart rate, and total cholesterol decreased over 8 years while glycosylated hemoglobin, waist circumference, and pulse pressure increased over that time. Both the statistical significance levels and the magnitudes of the reduction over time with age in diastolic blood pressure, resting heart rate, and total cholesterol in models adjusted for age, race/ethnicity, gender, smoking, and education were reduced after controlling for blood pressure and cholesterol medication.

CONCLUSIONS: The relatively constant total CMR level over 8 years occurred because some indicators improved with age while some deteriorated in this period. Medication use contributed to the improvement in blood pressure, resting heart rate, and total cholesterol.

%B The Journals of Gerontology, Series A %V 76 %P 2265-2274 %G eng %N 12 %R 10.1093/gerona/glab205 %0 Journal Article %J Journal of Alzheimer's Disease %D 2021 %T Education Differences in the Adverse Impact of PM2.5 on Incident Cognitive Impairment Among U.S. Older Adults. %A Jennifer A Ailshire %A Katrina M Walsemann %K Aging %K Air Pollution %K Cognition %K Dementia %K Education %K Modifiable risk factors %X

BACKGROUND: Air pollution is linked to worse cognitive function in older adults, but whether differences in this relationship exist by education, a key risk factor for cognitive decline, remains unknown.

OBJECTIVE: To determine if the association between fine particulate matter air pollution (PM2.5) and incident cognitive impairment varies by level of education in two cohorts assessed a decade apart.

METHODS: We used data on adults ages 60 and older from the nationally representative Health and Retirement Study (HRS) linked with tract-level annual average PM2.5. We used mixed-effects logistic regression models to examine education differences in the association between PM2.5 and incident cognitive impairment in two cohorts: 2004 (n = 9,970) and 2014 (n = 9,185). Cognitive impairment was determined with tests of memory and processing speed for self-respondents and proxy and interviewer assessments of cognitive functioning in non-self-respondents.

RESULTS: PM2.5 was unrelated to incident cognitive impairment among those with 13 or more years of education, but the probability of impairment increased with greater concentrations of PM2.5 among those with 8 or fewer years of education. The interaction between education and PM2.5 was only found in 2004, possibly because PM2.5 concentrations were much lower in 2014.

CONCLUSION: Education is a key determinant of cognitive decline and impairment, and in higher pollution contexts may serve as a protective factor against the harms of air pollution on the aging brain. Additionally, because air pollution is ubiquitous, and particularly harmful to vulnerable populations, even small improvements in air quality may have large impacts on population health.

%B Journal of Alzheimer's Disease %V 79 %P 615-625 %G eng %N 2 %R 10.3233/JAD-200765 %0 Journal Article %J The Journals of Gerontology: Series B %D 2021 %T Family caregiving and place of death: Insights from cross-national analysis of the Harmonized End of Life Data. %A Jennifer A Ailshire %A Osuna, Margarita %A Wilkens, Jenny %A Jinkook Lee %K Activities of Daily Living %K Aging %K Disability %K family caregivers %K Nursing homes %K SHARE %K spouse %K Terminally Ill %X

OBJECTIVES: Family is largely overlooked in research on factors associated with place of death among older adults. We determine if family caregiving at the end of life is associated with place of death in the United States and Europe.

METHODS: We use the Harmonized End of Life data sets developed by the Gateway to Global Aging Data for the Survey of Health, Ageing and Retirement in Europe (SHARE) and the Health and Retirement Study (HRS). We conducted multinomial logistic regression on 7,113 decedents from 18 European countries and 3,031 decedents from the United States to determine if family caregiving, defined based on assistance with activities of daily living, was associated with death at home versus at a hospital or nursing home.

RESULTS: Family caregiving was associated with reduced odds of dying in a hospital and nursing home, relative to dying at home in both the United States and Europe. Care from a spouse/partner or child/grandchild was both more common and more strongly associated with place of death than care from other relatives. Associations between family caregiving and place of death were generally consistent across European welfare regimes.

DISCUSSION: This cross-national examination of family caregiving indicates that family-based support is universally important in determining where older adults die. In both the United States and in Europe, most care provided during a long-term illness or disability is provided by family caregivers, and it is clear families exert tremendous influence on place of death.

%B The Journals of Gerontology: Series B %V 76 %P S76-S85 %G eng %N Supplement_1 %R 10.1093/geronb/gbaa225 %0 Journal Article %J Innovation in Aging %D 2020 %T Cardiometabolic Risk and Biomarker Trajectories Among Older Adults: Findings From the Health and Retirement Study %A Wu, Qiao %A Eileen M. Crimmins %A Jennifer A Ailshire %A Jung K Kim %A Zhao, Erfei %K biomarker trajectories %K cardiometabolic risk %X The deterioration of the cardiovascular system is a process associated with aging. Most of the prior works have examined changes in cardiometabolic risk (CMR) while aging at the population level using cross-sectional data, but we study within-person changes for total CMR and separate risk factors, including pulse pressure, resting heart rate, C-reactive protein, glycosylated hemoglobin (HbA1c), high-density lipoprotein cholesterol, total cholesterol, waist circumference, and obesity. We examine 8-year changes (from 2006 to 2014) among respondents from the Health and Retirement Study biomarker sample (n=19,776). We use growth curve models to identify differences at baseline and the changes while aging, by age, gender, race/ethnicity, and education. Blacks, the old-old, the less educated, and current smokers have higher baseline CMR. The total CMR increases while people age over 8 years. HbA1c, waist circumference, and pulse pressure increase significantly with age. A reduction in total cholesterol can be observed and is likely due to medication. The CMR increase is no longer significant after accounting for socioeconomic status. The next step of this study is to focus on the disparity of risk distribution, in order to identify the individuals that are most in need of specific care and support. %B Innovation in Aging %V 4 %P 429 %@ 2399-5300 %G eng %N Supplement_1 %R https://doi.org/10.1093/geroni/igaa057.1386 %0 Journal Article %J American Journal of Epidemiology %D 2020 %T Early Educational Experiences and Trajectories of Cognitive Functioning Among Mid-Life and Older U.S. Adults %A Katrina M Walsemann %A Jennifer A Ailshire %X Educational attainment is often considered the most important protective factor against cognitive impairment and dementia, yet significant variation in early educational experiences exists among mid-life and older U.S. adults. We use prospective data from the Health and Retirement Study (HRS) along with information on respondents’ early educational experiences collected in the 2015 and 2017 HRS Life History Mail Survey (HRS-LHMS) to examine if school context, educational content, and academic ability are associated with trajectories of cognitive functioning and whether educational attainment explains this relationship. We restrict our sample to age-eligible HRS-LHMS respondents who provided data on cognitive functioning at least once from 1998 to 2014, and attended primary school or higher (n=9,565 respondents providing 62,037 person-period observations). Estimates from linear mixed models revealed that school context, educational content, and academic ability were significantly associated with level of cognitive functioning, but not to rate of cognitive decline. Educational attainment explained from 9\% to 55\% of the association between these early educational experiences and level of cognitive functioning; however, all relationships remained statistically significant. Our results suggest that educational experiences that span childhood and adolescence are independently related to level of cognitive functioning decades later. %B American Journal of Epidemiology %8 01 %G eng %U https://doi.org/10.1093/aje/kwz276 %R 10.1093/aje/kwz276 %0 Journal Article %J Res Aging %D 2011 %T BMI Trajectories During the Transition to Older Adulthood: Persistent, Widening, or Diminishing Disparities by Ethnicity and Education? %A Katrina M Walsemann %A Jennifer A Ailshire %X

Previous research has produced inconsistent results on whether education and ethnic disparities in body mass index (BMI) persist, widen, or diminish over time. The authors investigate how education and ethnicity, independently and conditionally, influence BMI trajectories during the transition to older adulthood. Employing random coefficient modeling, the authors analyzed eight biennial waves of data (1992-2006) from the Health and Retirement Study, a nationally representative longitudinal study of individuals born between 1931 and 1941. After adjusting for health behaviors and health status, education and ethnic disparities in BMI persisted for most groups, but narrowed between high-educated White men and both low-educated Hispanic men and high-educated Black men. As such, the findings generally support the persistent inequality interpretation. Therefore, even though interventions targeted at earlier points in the life course may be effective in reducing BMI disparities in later life, social and health policies directed at reducing obesity among older adults is also warranted.

%B Res Aging %I 33 %V 33 %P 286-311 %8 2011 May %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/30089935?dopt=Abstract %4 Body mass index/Older people/Ethnicity/Education/Health behavior/Obesity/Aging %$ 62500 %R 10.1177/0164027511399104 %0 Journal Article %J Social Science & Medicine (1983) %D 0 %T State-level desegregation in the U.S. South and mid-life cognitive function among Black and White adults. %A Walsemann, Katrina M %A Hair, Nicole L %A Farina, Mateo P %A Tyagi, Pallavi %A Jackson, Heide %A Jennifer A Ailshire %K Education %K historical data %K life course %K school segregation %X

RATIONALE: Black adults experience worse cognitive function than their White peers. Although educational attainment is an important predictor of cognitive function, other aspects of education, including school desegregation, may also shape this relationship. For Black adults who grew up in the U.S. South in the 1950s-1970s, exposure to school desegregation may have altered life course pathways critical for later cognitive function.

OBJECTIVE: We determined if state variation in exposure to school desegregation in the U.S. South was associated with cognitive function at mid-life, if the association varied by race, and if the association remained after adjustment for state-level education quality and respondents' educational attainment.

METHODS: We linked historical data on state-level school desegregation to the Health and Retirement Study, a nationally representative sample of U.S. adults aged 50 and older. We restricted our sample to Black (n = 1443) and White (n = 1507) adults born between 1948 and 1963 who resided in the U.S. South during primary school. We assessed three cognition outcomes: total cognitive function, episodic memory, and mental status. We estimated race-stratified linear regression models with cluster adjustment and a final model using state fixed effects.

RESULTS: Greater exposure to desegregated primary schooling was associated with higher cognitive function and episodic memory among Black but not White adults. Among Black adults, the association between school desegregation and cognitive function and episodic memory remained after adjustment for state-level education quality and educational attainment.

CONCLUSIONS: Our findings suggest that state-level school desegregation efforts played a consequential role in shaping the cognitive function of Black adults who grew up in the U.S. South.

%B Social Science & Medicine (1983) %V 338 %P 116319 %G eng %R 10.1016/j.socscimed.2023.116319